Dr Richard Shepherd
U N N AT U R A L C A U S E S
Contents
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Author’s Note
Acknowledgements
Follow Penguin
’Tis not enough, Taste, Judgement, Learning, join;
In all you speak, let Truth and Candour shine:
That not alone what to your Sense is due,
All may allow; but seek your Friendship too.
Be silent always when you doubt your Sense;
And speak, tho’ sure, with seeming Diffidence:
Some positive, persisting Fops we know,
Who, if once wrong, will needs be always so;
But you, with Pleasure own your Errors past,
And make each Day a Critick on the last.
’Tis not enough your Counsel still be true;
Blunt Truths more Mischief than nice Falsehoods do;
Men must be taught as if you taught them not;
And Things unknown propos’d as Things forgot.
Without Good Breeding, Truth is disapprov’d;
That only makes Superior Sense belov’d.
Be Niggards of Advice on no Pretence;
For the worst Avarice is that of Sense:
With mean Complacence ne’er betray your Trust,
Nor be so Civil as to prove Unjust.
Fear not the Anger of the Wise to raise;
Those best can bear Reproof, who merit Praise.
Alexander Pope, An Essay on Criticism
1
Clouds ahead. Some were snowy mountains looming over me. Others lay
across the sky like long, sleeping giants. I moved the controls so gently that
when the plane tilted down and to the left it seemed to respond not to
command but by instinct. Then, ahead of me, the horizon straightened. It is
a strange friend: always there, glimmering between sky and land,
unapproachable, untouchable.
Beneath were the North Downs, their gentle curves bearing an odd
similarity to the rise and fall of the human body. Now they were sliced
cleanly through by the motorway. Cars chased each other along its deep cut.
They gleamed like tiny fish. Then the M4 was gone and the earth was
falling away towards water, a river knitted with a complexity of tributaries.
And here a town, its centre robust, red-hearted, radiating roads lined by
paler, more modern buildings.
I swallowed.
The town was disintegrating.
I blinked.
An earthquake?
The town’s colours waved. Its buildings were pebbles on a riverbed,
viewed through the distorting lens of flowing water.
Extraordinary air currents?
No. Because the town waved in time with something inside me,
something like nausea. But more ominous.
I blinked harder and my hand tightened on the plane’s controls as if I
could correct this feeling by correcting altitude or direction. But it came
from deep inside me, forcing its way up through my body with a physical
power that left me breathless.
I am a practical, sensible man. I looked for practical, sensible
explanations. What had I eaten for breakfast? Toast? Harmless enough and
offering no explanation for the sudden intensity of this sickness. And if it
wasn’t exactly nausea, then what? Its chief component was an inexplicable
sense of unhappiness, and … yes, dread. A sense that something terrible
was about to happen. Even … an urge to make it happen.
A ludicrous, irrational thought crossed my mind. What if I got out of the
aeroplane?
I struggled with myself to remain seated, to keep breathing, to control the
plane, to blink. To be normal again.
And then I glanced at the GPS. And read: Hungerford.
Red, older houses at the centre. Hungerford. On its peripheries, grey
streets and playing fields. Hungerford.
And then it was gone, replaced by Savernake Forest, a vast green cushion
of vegetation. Gradually the great forest brought me relief, as if I were a
foot-traveller enjoying its leafy shade. If my heart rate was still raised the
cause was retrospective horror. What had happened to me back there?
I am in my sixties. As a forensic pathologist, I have performed more than
20,000 post-mortems. But this recent experience was the first time in my
entire career that I suspected my job, which has introduced me to the human
body in death after illness, decomposition, crime, massacre, explosion,
burial and pulverizing mass disasters, might have emotional repercussions.
Let’s not call it a panic attack. But it shocked me into asking myself
questions. Should I see a psychologist? Or even a psychiatrist? And, more
worryingly, did I want to stop doing this work?
2
The Hungerford massacre, as it became known, was my first major case as
a forensic pathologist and came absurdly soon after I began my career. I
was young and keen and it had taken many years to qualify. Years of highly
specialized training, far beyond routine anatomical and pathological study. I
must admit that so much time spent staring at minute cellular differences on
microscope slides nearly bored me into giving it up. On many occasions I
had to reinspire myself by sneaking into the office of my forensic mentor,
Dr Rufus Crompton. He let me read through his files and look at the
booklets of photographs from his cases and sometimes I’d sit there,
engrossed, long into the evening. And by the time I left I could remind
myself why I was doing all this.
At last I qualified. I was rapidly installed at Guy’s Hospital, in the
Department of Forensic Medicine, under the wing of the man who was then
the UK’s best-known pathologist, Dr Iain West.
In those days, the late 1980s, pathologists were expected to join senior
police officers as hard-drinking, tough-talking, alpha males. Those who
carry out necessary work that repulses others often feel entitled to walk
with a swagger in their step and Iain had that swagger. He was a charismatic
man, an excellent pathologist and a bull in the witness box who was not
scared to lock horns with counsel. He knew how to drink, charm women
and hold a public bar spellbound with a good story. Although sometimes
rather shy, I had almost convinced myself I was socially competent until I
found myself playing the gawky younger brother to Iain. His light shone in
pubs across London and I stood with an admiring audience in his shadow,
seldom daring to risk adding a quip of my own. Or perhaps that was just
because I couldn’t think of a good one, anyway not until at least an hour
later.
Iain was head of department and it was quite clear that he was top dog.
The Hungerford massacre was a significant national disaster and a personal
tragedy for the people of that town, especially those families directly
affected. Under normal circumstances, Iain, as boss, would rush to such an
event. But it was mid-August and he was on holiday so, when the call came,
I took it.
I was driving home from work when my bleeper went off. It is difficult to
imagine now that we lived in a world without mobiles but in 1987 there was
nothing more than a single bleep to alert me to the fact that I should make a
phone call as soon as I could. I switched on the radio, just in case the bleep
was related to a headline. And found it was.
A gunman had been on the loose around a town in Berkshire so obscure
that I had never visited and barely heard of it. He had been on a killing
spree, starting in the Savernake Forest and working his way towards
Hungerford town centre, and now he had retreated into a school building
and the police had surrounded him. They were trying to persuade him to
give himself up. Reporters believed that he may have killed as many as ten
people, but since the town was under a sort of curfew there was no way of
obtaining an accurate figure.
I arrived home, which in those days was a nice house in Surrey. A happy
marriage, a nanny, two small children playing in the garden: it couldn’t
have contrasted more with the houses of murder scenes I visited. On that
day, I knew my wife, Jen, probably wouldn’t be there yet because she was
busy studying.
I walked through the front door and straight to the phone, saying goodbye
to the nanny as she left. I got the up-to-the-minute information and
discussed with the police and coroner’s office whether I needed to go to
Hungerford this evening. They were adamant that I must. I promised to
leave as soon as my wife returned.
Switching on the radio news, I listened to Hungerford updates while I
made the children tea. Then I bathed them, read a story and tucked them
into bed.
‘Sleep well,’ I said. I always did.
I was the caring parent focusing on his children. And simultaneously the
forensic expert desperate to get in the car and see what was happening in
the biggest case of his professional life so far. When Jen walked in, the
forensic expert took over entirely. I kissed her goodbye and sprinted straight
out.
The CID had instructed me to leave the M4 at Junction 14 and wait on
the slip road for my police escort. A few moments later a police car slid
alongside mine and two grim faces turned to me.
They offered no greetings.
‘Dr Shepherd?’
I nodded.
‘Follow us.’
Of course, I’d been listening to the radio all the way and I already knew
that the massacre had ended with the death of the gunman. He was twentyseven-year-old Michael Ryan, who, for no reason anyone could discern, had
roved Hungerford armed with two semi-automatic rifles and a Beretta
pistol. He was dead now, either because he had turned a gun on himself or a
marksman had saved him the trouble. Reporters were excluded, the injured
had been taken to hospital, residents were indoors and the town had been
left to the police and the dead.
We passed through a roadblock and I followed the police car very slowly
along eerily empty streets. The last long rays of the evening’s summer sun
were passing across this ghost town, bathing it in a benign, warm light.
Anyone alive was inside their home but there was no sense of their presence
at the windows. No car moved apart from our own. No dog barked. No cat
prowled through flower beds. Birds were silent.
As we twisted and turned through the town’s small suburbs we passed a
red Renault askew at the side of the road. A woman’s body was slumped
over the wheel. Further on, as we turned into Southside, were the
smouldering remains of Ryan’s house on the left. The road was blocked. A
police officer’s body sat motionless in his squad car. The car was riddled
with bullet holes. A blue Toyota had collided with it and inside was another
dead driver.
An elderly man lying by his garden gate in a pool of blood. On the road
an elderly woman, dead. Face down. I knew from news reports that this
must be Ryan’s mother. She lay outside her burning house. Further on, a
man on a path, dog lead in hand. The juxtaposition on that almost-dark
August evening between the quotidian streets and the extraordinary random
acts of killing that had taken place there was, frankly, surreal. Nothing at all
like this had happened in the UK before.
At the police station we halted. My door slammed and then the officer’s
door slammed and after that the heavy silence resumed to cover, no,
smother, Hungerford. It was a few years before I was to hear another such
silence, the silence that follows horror. Usually the scene of a homicide is
accompanied by the bustle of the living – uniformed officers, detectives,
crime scene investigators, people rustling paperwork, taking pictures,
making phone calls, guarding the door. But the enormity of that day’s
events seemed to have frozen Hungerford in a state I can only compare to
rigor mortis.
The police station was more of a police house: anyway, it was being
refurbished, with lumps of plaster on the ground and wires hanging. I must
have been greeted. I must have shaken hands. But it seems to me, looking
back, that the formalities were carried out in total silence.
It was soon completely dark and I was in a police vehicle, heading for the
school where Michael Ryan had barricaded and then shot himself.
We glided very slowly down the still street, the headlights picking up a
crashed car, its driver clearly visible, motionless. Once again, I climbed out
to look. The light from my torch slid over the feet, the torso, the head. Well,
there was no doubt here about the cause of death. A gunshot wound to the
face.
We stopped at the next car and then a couple more. The gunshot wounds
were in a different place each time. Some people had been shot once, some
had been shot again and again and again.
Recovery vehicles were waiting unobtrusively to take away the crashed
cars when the police had documented them and removed the bodies. I
turned to the officer driving me. My voice hit the silence like breaking
glass.
‘There’s no need for me to see any more of the bodies in situ. There’s no
doubt about how they died so I can deal with it all at post-mortem.’
‘We need you to take a look at Ryan, though,’ he said.
I nodded.
At the John O’Gaunt School there were many more police officers.
I was briefed downstairs.
‘He told us he had a bomb. We haven’t searched him yet because we
were worried that it would detonate if we moved him. But we need you to
have a look at him now and certify death. Just in case he blows up when we
do look. All right?’
‘Right.’
‘I suggest you don’t move him, sir.’
‘Right.’
‘Do you want a flak jacket?’
I declined. It was designed to stop bullets and so would have been of
little use at such close range to a bomb. And, anyway, I had no intention at
all of moving Ryan.
We went upstairs. That rubbery smell of school. And when they opened
the classroom door, there were desks. Some of the desks were scattered but
most still stood in neat rows. Pinned around the walls were pictures and
scientific diagrams. All perfectly normal. Apart from a body, propped up in
a sitting position at the front of the class near the blackboard.
The killer was dressed in a green jacket. He would have looked like a
man off hunting for the day if there hadn’t been a gunshot wound to his
head. His right hand lay in his lap. It held a Beretta pistol.
As I set off towards him, I was aware that all the policemen were quietly
leaving. I heard the door close behind me. From beyond it there came a
radio message: ‘Going in.’
I was on my own in a classroom with the UK’s biggest mass murderer.
And perhaps a bomb. I had been attracted to my profession by the books of
that lion of forensic pathology, Professor Keith Simpson. But I couldn’t
remember him mentioning this as a possibility in any of them.
I was acutely aware of everything around me. The quiet sounds beyond
the door. The arc lights outside throwing overlapping, dark shadows on the
ceiling. The small beam of my own torch. That classroom smell of chalk
and sweat, mixed strangely with the smell of blood. I crossed the room,
focusing on the body in the corner. On arrival, I knelt down to look at him.
The gun, which had already killed so many people that day, was pointing
straight at me.
Michael Ryan had shot himself in the right temple. The bullet had passed
through his head and out of the other temple. I saw it later as I left the room,
embedded in a noticeboard across the classroom.
I debriefed the officers. There were no hidden wires. The cause of death
was the gunshot wound to the right side of the head, which was typical of
suicide.
Then, relieved to be leaving that sad grave of a place, I gathered speed on
the motorway. But it seemed that Hungerford’s silence had infiltrated the
car and was riding alongside me, a massive and unwanted passenger.
Suddenly I was overwhelmed by all I had seen that day. The enormity of it.
The horror. I pulled over to the hard shoulder and sat in the dark car while
the lights of other vehicles swept by, unseeing, unknowing.
I only became aware of the police car which had pulled up behind me
when there was a tap at the window.
‘Excuse me, sir. Are you all right?’
I explained who I was and where I’d been. The officer nodded,
scrutinizing me, assessing me, wondering whether to believe me.
‘I just need a minute,’ I said, ‘before I continue.’
Police officers know about transitions between work and home. He
nodded again and returned to his own car. No doubt to check my story. A
few quiet minutes later and I knew I had left Hungerford behind and home
was ahead. I indicated, waved goodbye and rejoined the great river of
motorway traffic. The police car pulled out behind me, following me
protectively for a short distance before dropping back then turning off. I
continued my journey alone.
At home, the children were in bed and Jen was downstairs, watching TV.
‘I know where you’ve been,’ she said. ‘Was it awful?’
Yes. But I only allowed myself to shrug. I turned my back to her so that
she could not see my face. I felt I had to extinguish the television news with
its reporters discussing Hungerford excitedly and so urgently. The
Hungerford dead had no excitement or urgency any more. Here were men
and women simply slaughtered as they went about life’s business, business
they thought important and pressing until it was brought to an abrupt halt.
There was nothing important for them now. There was nothing pressing.
Late into the night I was busy making phone calls to sort out how I would
conduct multiple post-mortems the next day. I hoped to help the police
reconstruct every death and thus, with witness help, all Ryan’s moves.
Reconstruction is important. It matters a lot to anyone involved, and it
matters to the wider world. As humans, we have a need to know. About
specific deaths. About death in general.
The following morning I performed some routine post-mortems: drunks,
drug addicts and heart attacks, all at Westminster mortuary. While my
colleagues asked me for details of Hungerford, the police there were
moving the last bodies to the mortuary at the Royal Berkshire Hospital in
Reading. When I arrived at about 2 p.m. I was greeted by the staff and then
got to know them in our business’s time-honoured fashion, over a cup of
tea. A brew was and is regarded as a mortuary essential, both a right and a
duty before performing a post-mortem.
And then the door swung open and Pam Derby bustled in. The room was
filled with movement. Pam was our diminutive but crucially important
secretary.
‘Right!’ she said.
Always a commanding presence, she was now looking at her most
formidably efficient. Two unhappy mortuary assistants struggled behind her
with the computer.
‘Where can I plug in?’
This wasn’t a question, it was a demand. Office computers were in their
infancy in 1987 and they were very large infants. In fact, ours must have
hatched from a dinosaur egg as Pam had to bring it down from Guy’s in a
van.
She saw that I was in my green apron and white wellies, just starting to
get the external examinations and X-rays organized. I was ready to go.
‘No, no, no, you can’t start until the computer’s warmed up and it takes
at least ten minutes or you’ll get too far ahead of me. Make me a cup of
tea,’ she instructed. Iain West was clearly deluding himself that he ran the
department.
While the computer and the kettle whirred, Pam sat down at the
keyboard.
‘Not much point in all this nonsense; they’ve been shot, anyone can see
that,’ she said briskly. Pam was familiar with the emotional, unplanned
chaos of real homicides. That’s why she and the other staff, for relaxation,
often read neatly plotted whodunits, where the murderer leaves clear clues
and at the end the pieces of the jigsaw click into place. It’s all so different
from the many versions of the truth, the conflicting facts and interpretations
of them which are the messy face of real investigations.
She was right, there were no mysteries ahead today. But each case was a
sibling, a parent, a child, a lover. Each was special to family and friends and
each presented a unique puzzle for me to solve. The six tables stretched to
the end of the room with a body on alternate surfaces: the empty tables in
between were to be used for bagging and documenting the hundreds of
exhibits we were going to take.
The first body was Michael Ryan. Probably most bereaved relatives did
not wish him to share a mortuary with his victims, let alone a post-mortem
room. In fact, everyone just wanted him to go. The press was still hinting
with smug glee that he had been ‘taken out’ by the SAS – despite the police
press release which confirmed, after my visit the night before, that he had
committed suicide. Now we also needed to say that the post-mortem
confirmed his suicide.
A post-mortem, also called an autopsy, is carried out in two situations. It
may be performed after a natural death, usually in hospital, despite the
cause of death being known, to confirm the patient’s medical diagnosis and,
possibly, examine the effects of treatment. The deceased’s immediate
family will be asked to agree to a post-mortem and will have an absolute
right to decline. Fortunately, many agree. Their decision can help other
patients by giving medical staff a superb opportunity to learn and improve.
Agreeing to such a request for a post-mortem is, I think, a very generous
act.
The second situation occurs when the cause of death is unknown or
where there is a possibility it is unnatural. In this case, the death is referred
to the coroner. All suspicious, unnatural, criminal or unexplained deaths
have not just a post-mortem but a forensic post-mortem. This is a complete
and extremely detailed investigation of the outside and the inside of the
body. Afterwards these details are recorded by the pathologist in the postmortem report.
The report must confirm the formal identification of the deceased and
this alone is often a very long and complex process, and one which
occasionally can never be completed. The report also explains why the
post-mortem was requested by the police or the coroner. It lists those
present while it was carried out. It gives details of any subsequent
laboratory tests.
The bulk of the report is a description of exactly what the pathologist has
found. We usually offer some interpretation of these findings and at the end
we give a cause of death. If we don’t know why the person died we say so –
although usually after discussing the possibilities.
Despite all our years of training on the macro- and microscopic
appearances of the organs in thousands of diseases, just looking carefully at
the body before us is often the most vital part of the post-mortem. During
this detailed external examination, we measure and record the size, location
and shape of every scratch and bruise as well as any bullet holes and stab
wounds. This may seem simple compared with our medical analysis of the
body’s interior but it has often proved the most important part of
reconstructing a homicide. It is all too easy to regard external examination
as a mere formality, and therefore to rush it. Then, long after a body has
been cremated, we might regret those skimpy notes.
Michael Ryan was a mass murderer. He killed sixteen people and there
were almost as many wounded. My career so far had focused on the victims
of accidents, crime or just bad luck. I seldom saw perpetrators, and had
certainly never seen someone who had caused so much death and injury.
Could I, should I, treat Ryan with the same respect I showed his victims?
I knew I had to. Feelings have no place in the post-mortem room. I
suspect that one of the greatest skills I have learned is not to feel a moral
repulsion which others might think is not only justified but required. So
whatever I felt about this young man and his actions, I excluded that from
my mind and my heart. I knew that his examination required as much, or
maybe even more, care and attention than others. Only after a thorough and
conclusive physical investigation could I furnish the coroner with the
information he needed to confidently give the correct verdict at the inquest.
I knew that proof was crucial for this verdict, to quell any future challenges
or the inevitable conspiracy theories.
It was hard to imagine that the slender young man who lay naked on the
post-mortem table had just finished a killing spree. Everyone in the room –
police officers, mortuary staff, even Pam – stared at him with
incomprehension. He looked as vulnerable as any victim of crime, as any of
his own victims.
Then I got on with my job: fully to examine him, particularly the entry
and exit wounds in his head. Next to open his body up for internal
examination, taking samples for toxicology. And finally to trace the bullet’s
trajectory through his brain.
As I started work, the place was plunged into absolute and total silence.
No calling. No rattling. No banging. No kettles or cups of tea. Just silence.
Even the temperature seemed to drop significantly. As soon as I had
finished, he was wheeled away. No one wanted to be near him, this strange
young man who had lived quietly with his mother harbouring an obsession
with firearms and thinking God knows what thoughts.
Now I started on Ryan’s victims, and I could see it would be a long, hard,
stressful day. Fridges clanged open and shut as we completed one postmortem and started another. Apart from this, and my voice dictating to Pam,
the room remained silent. I was helped by a trainee pathologist, Jeanette
MacFarlane. Pam typed at my dictation and a rolling rota of photographers
and police officers followed me from table to table, the most senior taking
notes, others taking my exhibits.
Behind me the mortuary staff worked, cleaning bodies then sewing them
up and preparing them for their families to see.
The deaths were straightforward, all from gunshot wounds. Not one
victim had seen Ryan bristling with weapons and simply dropped dead from
a heart attack. But it was my job to look for any natural disease that might
have caused or hastened death. Once again, I had to carefully document
each wound, describe it, analyse it, follow the trajectory of the bullet or
bullets. I walked around each body, directing the photographer, measuring
wounds, noting abnormalities, chanting my liturgy to Pam. Gradually a
picture of Ryan’s day of madness emerged.
Generally, victims who were killed with only one shot had been killed
from a distance. If he got close to a victim, Michael Ryan apparently had
the urge to fire more often.
When his mother, a dinner lady, heard from a friend what was going on,
she came home to remonstrate with him. The friend drove her to Southside
and she walked up the road towards their home, past injured and dead
people, approaching her son fearlessly.
She said, ‘Stop it, Michael!’
He faced her and shot her once in the leg with the semi-automatic rifle.
This brought her face-down on the ground. In my opinion, it was his
intention only to maim her with that shot. He then walked up to her, stood
over her and shot her twice in the back to kill her.
These last two shots showed the typical soot and burning around the
wound when a weapon has been fired from close range, maybe from within
six inches. Perhaps he simply could not look at her face as he murdered her.
Until she arrived he had remained in the small area around his house and I
personally formed the theory that her death released him to rampage much
more widely through the town. I thought this had set him free to revel in the
experience of an extraordinary and unaccustomed power, the power his
weapons gave him over the unarmed.
Over the next few days I continued with my strange work, slowly moving
from body to body. Death for these victims was an unexpected, violent end
to peaceful and perhaps otherwise uneventful lives. Everyone in the
mortuary was greatly moved by this, but we could not allow ourselves to
give in to our sense of horror, or even to feel upset. Shock has no place in
the work of a pathologist. We must seek the truth with clinical detachment.
In order to serve society we sometimes have to suspend some aspects of our
own humanity. I believe that same suspended humanity powerfully
reasserted itself as I flew over Hungerford almost thirty years later.
In fact, it has taken me all this time to admit that I was very deeply
affected by the massacre. I did not then acknowledge to myself shock or
sadness, not in any way. My colleagues, alpha males or aspiring to be, were
my role models, and they would never have shown or expressed such a
thing, nor allowed themselves to think it. No, in order to do this work, I had
to remember the professional integrity of the forensic pathologist Professor
Keith Simpson that had inspired me in my teens to pursue my training. Was
shock or horror something he ever wrote about? No it was not.
When Iain came back from holiday he did not ask me about Hungerford,
he did not offer me advice or refer to the events there in any way at all. It is
certain that he was livid with me for taking on such a huge case in his
absence, although it was my job to cover his holiday period. Could I have
located him to recall him from holiday? Perhaps, and, for this, he would
certainly have come. We both knew that such a huge case should have been
his: he had dealt with many IRA bombings and bullets; indeed, ballistics
was his speciality.
The face of his fury was froideur, but gradually reports leaked out from
colleagues that Iain believed one of the stupidest parts of Ryan’s rampage
was to do it while he, Iain, was on holiday. And among ourselves we added
that, as if that wasn’t stupid enough, Iain privately thought Ryan was an
idiot to shoot himself, depriving the renowned Dr West of a spectacular
court appearance.
For a long time, Hungerford lay between us, but there was no doubt my
position at Guy’s, and probably throughout the UK, shifted as a result of my
work there. I was no longer the gawking, younger brother and doting
follower of Iain. I was a noted forensic pathologist in my own right.
3
My strange, emotional flashback to the events of 1987 in Hungerford was
all too easy to ignore once I had made the radio calls, turned the plane onto
final approach and landed safely. It’s a Cessna 172 that I share with a
syndicate of twenty or so other people in Liverpool. It is my pleasure (and
my madness, because door-to-door the train is nearly always quicker), to fly
to meetings and post-mortems in other parts of the UK and Ireland as often
as I can.
I bounced along the landing strip at the grassy little airfield in broad
sunshine, found my stand and shut down the engine. I left the Cessna and
saw my colleague waiting for me. I felt fine. As we drove off I began to
wonder if I had imagined that something had happened up there. Perhaps I
had been short of oxygen in the cockpit? Well hardly, at 3,000 feet.
Anyway, I was now sure my reaction could not have been as violent as I
remembered. Not a panic attack at all, really.
As I flew back later, the more variable weather conditions demanded my
undivided concentration and I hardly thought about Hungerford. Except to
avoid it. It did occur to me then, for the first time, that the pilot’s
preoccupation with staying alive, which so powerfully suppresses all other
thoughts, feelings and fears, may be one of the reasons I fly.
Home at last, the clouds cleared to reveal a soft summer’s evening. I
made myself a whisky and soda and sat outside on the patio to enjoy the last
rays of the setting sun.
But suddenly, unexpectedly, the pearly summer dusk, and that hushed
stillness which accompanied it, reminded me of … Hungerford. Again. My
heart beat faster. I felt strangely lightheaded – and I hadn’t taken one sip of
my drink. Once more I was moving slowly through a small town’s streets as
bodies lay unmoving in pools of blood by lawnmowers, in cars, across the
pavement. A sense of dread began to grip my chest and squeeze it hard.
I breathed deeply. To calm down. I reminded myself that I now knew
what was happening. I had established my own mind was playing tricks.
Obviously. So, with great effort, I must be able to control it. Obviously.
More breathing. Close my eyes. I had to crush this, crush it like ice inside
curled fingers.
Gradually my body relaxed. My clenched fist loosened. My breathing
deepened. I raised the glass unsteadily to my lips. Yes. Everything was back
under control.
By the time I had drained the glass, I could safely answer the two
questions I had asked myself in the plane that morning. No, of course I
didn’t need to see a psychologist, and certainly not a psychiatrist: the very
idea seemed absurd. And there was no good reason for me to stop practising
as a forensic pathologist either. Whatever was happening to me today would
soon pass and all would be well. For sure.
A few months later, in the autumn of 2015, co-ordinated terrorist attacks on
Paris bars, restaurants, a sports stadium and a music venue claimed 130
lives and injured hundreds of others. I was out on a call when I heard the
radio news. Behind the reporter were the wails of sirens which accompany
every emergency and the gabble of shocked voices. Horror’s soundscape. I
had to stop the car.
Sitting in a lay-by near my house, I closed my eyes. But they could still
see, and my ears could hear. Ambulance blue lights. Police barriers. Rows
of post-mortem tables under the bright mortuary glare, and on them human
body parts. Shouting. Police radios. The cries of the wounded. Before me,
bodies. In my nostrils, the smell of death. A foot, a hand, a child. A young
woman who had been dancing in a nightclub, her intestines unwinding.
Men in suits and ties but without legs. Office workers, tea ladies, students,
pensioners. Destroyed, every one of them.
I don’t know which of the disasters I have seen I was looking at now: the
Bali bombs, the 7/7 London bombing, the Clapham rail disaster, the sinking
of the Marchioness, 9/11 in New York, the Whitehaven massacre … or
maybe it was all of them.
I waited at the roadside for the tidal wave that was engulfing me to
subside. When it was over, I was left with a sense of misery and dread. The
smell of human decay seemed to linger in the car for some minutes. I took
deep breaths. It passed.
I drove off, shocked but under control.
Maybe I did need to discuss this with a professional after all. A priest,
perhaps? Some person, anyway, whose job it is to receive our weaknesses
and offer us strength.
Involuntarily I shook my head. Of course not. The events in Paris were
terrible but I had not been called to help and they were nothing to do with
me. I had a thorough understanding of death and no fear of it. The news
from Paris had unexpectedly opened up a seam of memories, but the
crevasse had closed again now. Aware of the long night of work that lay
ahead of them, I just felt sorry for my French colleagues.
So I continued my journey. Off to the mortuary and business as usual.
Surely I would be just fine.
4
From an early age I have had a relationship with death that is both intimate
and distant. I come from a comfortable home near London. My father was a
local authority accountant who had moved with my mother from the north
of England to seek his fortune in the south. There was no fortune but we
were well enough off: people who like categories would have called us
lower middle-class. My sister is ten years older than me and my brother
five. I was the loved baby of the family and we were unusual in only one
respect. Our mother had a heart complaint that meant she was gradually
fading away.
She had contracted rheumatic fever as a child and one of the
complications of that childhood infection was that her mitral heart valve
was progressively damaged. I know that now. Then, all I knew was that she
was frequently breathless even after only a little exercise and, unlike other
people’s mothers, often had to sit down.
My big sister, Helen, assured me that my mother had once been a vibrant,
laughing woman who mercilessly dragged my reluctant and rather dour
father onto the dance floor at every opportunity. Who had set off as a young
woman with him on a bicycle-built-for-two on a tour of Europe just when
war was about to break out. Who was always the life and soul of the party.
I liked to sit in the living room listening to my sister’s stories about our
mother. Walls, in those days, were rather bare, but carpets overcompensated
for this in swirliness. In the corner was a tiny black-and-white television,
one in which the white dot at the centre of the screen persisted when you
switched off the picture, enduring mesmerizingly for several minutes in the
dark. There was a radiogram (a huge combination of record player and
wireless), its front covered in gauze, from which issued mainly light
classical music of the type considered improving by the aspiring middle
classes.
The electric fire glowed warmly, although probably with more light than
heat. And the armchairs may have been worn but they were strategically
covered by antimacassars. Yes, it was cheering to listen on the loud livingroom carpet to tales of that lively woman. But she seemed to have nothing
in common with the mother who often languished in bed. Upstairs. Or in
hospital.
Her hospitalizations were long and frequent, at least that is how it seemed
to me as a boy. I was often packed off to seaside holidays with my grandma
in Lytham St Annes, or to my aunt in Stockport, and didn’t discover until
long afterwards that this wasn’t so much for me to have fun on the beach or
to see my cousin but to allow my mother time for surgery and
convalescence.
At home with me, she certainly tried hard to be normal. She got up each
morning and packed me lovingly off to school (even very young children
walked to school alone in those days). It was only when, one day, I forgot
my violin and returned unexpectedly to find her back in bed, that I realized
she collapsed between the sheets each morning as soon as I left. She was as
shocked to witness my discovery as I was to make it. I fear I was so taken
aback that I even chided the poor woman. I wanted her to get better and be
that mother everyone said she once had been. But even I could see that she
was disappearing before my very eyes.
One day in December I came home from school and found her gone. She
was in a hospital I now know to be the Royal Brompton. More tests and
more bed rest. She was forty-seven.
I was taken to see her on Christmas Day. My memory of that visit has
almost broken beneath the weight of subsequent memories of the many
hospitals of my working life. I can dig down through the years, sifting
geological strata, until I reach Christmas 1961, but what I find there breaks
into fragments when I try to stare at it. It can only be captured in swift,
sideways glances.
I was aware that nine-year-olds were generally not welcome on the
wards. I was told to be on my best behaviour. Full of this knowledge, I was
led down high, echoing corridors. Busy nurses in smart, starched uniforms
scurried past us. On each side were vast rooms. A smell of disinfectant.
Through faraway windows, the yellowing light of a dull London day.
Turning suddenly behind my father into a large ward. Floorboards. A long
line of beds, all white, all ready for the next patient. In my memory, all of
them empty. Except for one. In it was my mother and, looking back, it
seems to me she was the only patient on the ward for Christmas.
I wish I could remember how my mother greeted me, how she looked at
me. I expect she hugged me and held my hand. I think she did. I expect I
climbed on the bed and showed her the toys I’d received. Maybe I opened
some presents with her. I think I did. I hope I did.
A few weeks later, on a cold January morning, I got up early as usual and
left the room I shared with my brother, Robert, to cross into my parents’
room and slide into bed with my father. I did that every morning. But today,
something was wrong. The bed was cold. The sheets were still tidy. It had
not been slept in.
I crept to the top of the stairs. Lights. Lights on in the house early in the
morning. And voices. They weren’t speaking normally, as if it were
daytime. They were night-time hushed voices, their register strange, singing
notes of alarm I didn’t recognize. I stole back to bed and lay there. Waiting.
Worrying. Something had happened and sooner or later someone would
explain it to me.
Eventually, our father came in.
Horrifically, shockingly, he was crying. We stared at him, Robert
blinking because he had just woken up.
Our father said, ‘Your mother was a wonderful woman.’
At nine, that was too subtle for me. Robert had to explain the significance
of the past tense, that our mother was in the past tense now. Because she
was dead.
Eventually, I learned that my father and sister had gone to visit her as
usual at the Royal Brompton the previous evening. She still wasn’t well, but
didn’t seem any worse. They wished her goodnight as usual and were just
leaving when the nurse took them aside and said, ‘You do realize how ill the
patient is? I’m afraid Mrs Shepherd probably won’t last the night.’
This was shocking news because the possibility of her death had simply
not occurred to anyone. If it had occurred to my father, or had been
suggested to him by medical staff, he had convinced himself it wouldn’t
happen. She was in hospital to get better. Family visited her. That’s how
things were. No one anticipated an end to it.
In fact, she was a terminal cardiac case. She had heart failure and had
now developed bronco-pneumonia, a disease which is often called Old
Folks’ Friend because it releases the weak from their suffering. She was
certainly unable to withstand pneumonia, even though there were now
antibiotics to treat that infection. If only penicillin had been discovered in
time to prevent rheumatic fever from damaging her heart as a child.
Years later, when I was a medical student, my father solemnly produced
her post-mortem report from some special drawer and asked me to explain
it. I told him how her body’s response to childhood rheumatic fever had
made chemicals in the blood that killed the bacteria. But those chemicals
had attacked not just the infection but also the body’s own tissues – in this
case, quite typically, the mitral valve of her heart. This valve, which
controls the flow of blood through the left side of the heart, had become so
scarred that it was stiff and jammed partly shut. Every time my mother went
into hospital for open-heart surgery, the surgeons literally poked their
fingers through the valve to free the valve cusps. Result: they flapped more
normally again and blood flow between the left atrium and the left ventricle
was restored. Or anyway, improved. For a while.
This was why she had so often disappeared to the hospital prostrate and
returned reinvigorated. But each time the improvement was smaller.
This was pioneering open-heart surgery for its era, at the forefront of
medical science, but it was no way to win a battle against a recalcitrant
heart valve which the patient’s own body was determined to destroy.
Indeed, by the time I got to medical school ten years later, such treatment
had already been superseded. Now she could have been fitted with a new,
synthetic heart valve and survived, leading an active life for many more
years.
I knew none of this at the time of my mother’s death. I didn’t know what
I was supposed to feel, either. Everyone looked at me with tears in their
eyes expecting something. But what? I went next door to my friend John’s
house. It was a Saturday and the whole family was there. His mother was
warm and tearful and John and I sat watching television cartoons together.
Even when they were funny, I thought I shouldn’t laugh.
It all happened again soon afterwards when I came home from school
and found the house full of relatives and flowers. I worked out later that the
funeral had taken place; it had not crossed anyone’s mind that I should go.
When I walked in they looked at me tragically. What were they expecting
me to do, to say? I felt nothing. Perhaps deep down I simply did not grasp
the concept of death. My mother had so often disappeared before and had
always come back. Possibly, despite appearances, I trusted her to return
again.
When I look back on the early years of my life, on my mother, I
remember little and feel nothing of her. Was this because of her frequent
absences in hospital and strange lack of presence even when at home? How
is it that I remember so much from that time about my grandmothers, my
brother, sister, father, aunt … but there is a void where she should be? And I
suppose there always will be.
After her death, the most surprising thing happened. My father changed. I
think he analysed what we had lost and tried to supply it by becoming both
mother and father. He stopped being dour and withdrawn and instead turned
into an immensely loving man. My big sister helped a lot, although she was
nineteen when my mother died and had already left home for teachertraining college. My father thought she might come back to look after the
lads but, wisely, she did not – although she remained the most loving and
supportive of elder sisters, even after her own marriage a few years later.
My father managed the house, shopping, cooking and working full-time
in an era when there were few single fathers and consumerism was so
undeveloped that shops were invariably closed when working people could
visit them. He firmly believed it was possible to do anything you set your
mind to. So, he rewired the house and painted the kitchen and serviced the
car and learned to cook (with, admittedly, variable results). In addition, he
somehow arranged his life to accommodate our needs and this involved his
discovery of a new ability to give and receive great affection. I look back on
all this and feel huge admiration for him.
There is a small black-and-white picture of my father with a large, leggy
child, who must be me, enveloped in his lap. Both of us are asleep. This
picture is most unusual for its time. Post-war men, on the whole, had been
brought up by Victorian fathers and simply did not know how to show their
sons such a degree of love and kindness.
He ensured I had a good childhood. I enjoyed school, passed my elevenplus, loved swimming, went to the local youth club, sang in a choir and had
a lot of friends. One of these friends was the son of a GP. When we were
about thirteen, to spook us all, he ‘borrowed’ one of his father’s medical
books from the shelves at home and brought it to school. It was Simpson’s
Forensic Medicine (Third Edition) by Professor Keith Simpson, a small,
tatty, red book which promised nothing on the outside. But inside, it was
full of pictures of dead people. In fact, mostly murdered people. They were
strangled, electrocuted, hanged, knifed, shot, asphyxiated … no hideous
fate could escape Professor Simpson. He had seen everything. There was a
photo of the fern-like pattern on the skin that a lightning strike can leave, a
picture of the inside of the skull of a boy who had been hit on the head with
a brick and an astonishing gallery of bullet entry and exit wounds as well as
photos of bodies in various stages of decomposition.
I was, of course, by now all too familiar with the concept of death. I had
personally experienced many of its repercussions. But I knew nothing about
death’s physical presentation. My mother had died in hospital far away and
certainly no one had thought it appropriate for me to see her body. Even the
most amateur psychologist must deduce that my need to explore death’s
presentation was the reason for my extraordinary interest in that copy of
Simpson’s Forensic Medicine. More than an interest, it was a fascination. It
went further than prurience and much further than the other boys’ eagerness
to be horrified.
I borrowed the book and studied it for hours. I read and then reread the
text and stared at the accompanying pictures. They were certainly graphic,
especially since in those days no attempt was made to spare relatives, so
victims’ faces were not obscured.
Perhaps I wanted to view that horrifying thing, the worst that could
happen, that thing called death, through the detached, clinical, analytical
eyes of the great Simpson. Perhaps Simpson helped me to manage the
unmanageable. Or perhaps I was simply excited by this mixture of medical
knowledge and detective work.
I’d considered studying medicine. Pathology was interesting but forensic
pathology was medicine and then some. I understood that, unlike other
pathologists, the forensic pathologist does have patients. Unlike other
doctors, though, all his patients are dead. And there certainly could be no
comparison with the life of a GP, confronting a line of sniffing people every
morning.
I learned that the forensic pathologist was called to any suspicious death
at any time of the day or night, and that might mean to the actual scene of
an actual murder. His job (it was always a he in those days) was to carry out
a thorough medical analysis of the body to help police solve the crime.
There could be a man lying dead of gunshot wounds and the pathologist
would not only examine the scene and the wounds but also, said Simpson,
at once demand to see any firearms found in the vicinity.
He must then ask himself four questions:
1. Could the wound have been inflicted with that weapon?
2. At what range was it fired?
3. From what direction?
4. Could the wound have been self-inflicted?
And for Professor Keith Simpson, that was all in a day’s work. Thirsty to
know more, I read as much as I could about him and fell in love with the
way he rushed to crime scenes, often in those days by steam train, and then
used his medical skills to help detectives reconstruct homicides, solve the
unsolvable, exonerate the innocent, argue the case in court and bring to
justice the perpetrator.
My future became clear to me after that. My lofty ambition was to
become the next Professor Keith Simpson.
5
I was in an immense, clinical, white-tiled basement in Bloomsbury.
Overhead, lights glared. Before me, under a sheet, its shape eerily
discernible, lay the first dead body I would ever see.
All the medical students at University College London took Anatomy.
There were about seventy freshers, and we knew what Anatomy meant.
Dissection. I’d dissected a dogfish at school. Also a rat. Now we were
going to dissect a human body.
When I walked down the stairs and smelled the formalin I recognized it
at once from the school biology labs. We progressed through the room,
passing perhaps forty porcelain tables where dissections were still in
progress for the students from the years ahead of us. We threaded our way
carefully, knowing that there were bodies under those sheets. Then, when I
brushed past one, the sheet fell away at the corner to reveal a huge, hairy
gorilla foot. Ha ha, just part of the Comparative Anatomy course. I laughed
nervously. We all laughed nervously. Everyone was nervous.
For a lot of people, what we were about to do was scary or disgusting.
My own anxiety was different. I was still determined to become a forensic
pathologist like Professor Keith Simpson but I had actually only seen dead
humans in photos. So how would I react to my first dead body? I knew that
if I vomited, fainted, blanched or even faltered (and there were people in the
room on the verge of doing all that), then the career I’d set my heart on
would be over before it had begun.
Four to a table, wearing our new, crisp, white coats, we gathered around
the bodies. These bodies would stay with us throughout our Anatomy
course for eighteen months until we knew more about them physically than
they could ever have known themselves – but less about them personally
than any stranger who had shared a bus ride and seen their face in motion or
heard their voice.
While we waited for the tutor, we all tried, in our different ways, to
displace our emotions. But the unmistakable curves of those human forms,
lifeless beneath the sheets, changed the dynamic in our group. There was a
lot of bravado. Some made jokes, others felt obliged to laugh heartily. And
eyes met, people held each other’s gazes. A few invitations to date were
blurted out. The room throbbed with intense personal relationships under
this new and unaccustomed pressure.
Then the tutor started to speak and we stood to attention by our bodies.
His words were received in deep, deep silence. The harsh light bounced off
the tiles, off our lab coats, off the shiny scalpels and off our now tense,
drained faces.
The sheets were removed and there they were. The dead. Grey, still,
silent, unseeing. Some people fixed their eyes on the tutor. Others stared at
the naked form before them, or at its blank face.
On our table lay an elderly man. His eyes and mouth were closed, his
cheeks pronounced, the flesh beneath his chin firm, his hands by his sides,
his belly rotund, his knee joints arthritic, his feet wide. Vulnerable and
invulnerable. Human and yet not.
We were told when our bodies had died. A whole year ago in my group’s
case. This man had nobly bequeathed his mortal remains to medical science
and apparently we callow students were considered medical science. He had
been embalmed very soon after death and had then been immersed in
formalin until he was placed on this table. It was a little while before I came
to understand that his curious greyness was a feature of the formalin
injected to preserve him and not of death itself.
We were not told the names of our bodies or anything personal about
them, perhaps to dehumanize them a little. As I now knew Simpson’s
Forensic Medicine almost by heart I might secretly have been hoping for at
least a small gunshot wound, but it was explained to us that all the deaths
had been from natural causes and that we weren’t anyway looking for a
cause of death – although we might come across one. This was simply a
fundamental introduction to the human body and how it worked. We would
be seeing for ourselves how muscle connects to bone, we would be
uncovering nerve fibres, examining the plumbing around the kidneys and
the vessels around the heart.
We opened our manuals: Aitken, Causey, Joseph and Young’s A Manual
of Human Anatomy, Volume 1, Section 1: Thorax and Upper Limbs. The
tutor explained that we would start by cutting straight down the middle of
the chest. There was silence as he asked who, in each group, would take up
the scalpel. Who was ready to make the first incision into human flesh?
Me, that’s who. This was a big test for me. I had to know if I could do it.
I stared at the dead man’s face, a blank testament to its owner’s long
absence. What had he seen? What had he known? He had been a part of the
same world as us but in the year since his death that world had changed and
moved on and he had not. I looked at his chest. The skin on it was nothing
like my skin. It was firm but rubbery.
I picked up the scalpel. I had handled a scalpel before at school but this
one felt weighty. How much force would I have to put behind it to cut
through human flesh? The eyes of the group were fixed on me. No one
spoke.
A hand placed the scalpel on the body’s chest. I watched the hand and
realized it was mine. The group craned forward. I pressed down. Nothing
happened. I pressed harder and felt the skin give. I had made an incision. I
pulled the blade slowly, firmly down. The flesh parted cleanly as I cut, in as
straight a line as I could, from the jugular notch to the tip of the xiphoid
process. We were going to open this flap like opening a book and inside it
read the human body! I wanted to dig deeper, right now, and see what was
in there.
I was so immersed that I had forgotten the tutor, the other students, the
smell of formalin. When the tutor spoke, I looked up, blinking in surprise.
Around us, there was movement. At another table, a girl had fainted and
was surrounded by a circle of concern. Further down the vast room the
swing doors were slamming behind someone’s rapid exit. A few more
students were heading now towards those doors. One was a friend who was
never to return, either to Anatomy classes or medical studies. But among
those of us left, there was a new closeness. By dissecting a dead body, we
were becoming professionals together. We were joining a very small group,
a sect, a tribe. We were initiated. And for me, this maiden flight with the
scalpel confirmed my great hope: I belonged here.
As well as Anatomy classes, I was delighted to find that routine postmortems of patients who had died at University College Hospital were
performed daily at lunchtimes and that medical students were invited to
view them. And I often did, when a pint of beer and a pie in the Medical
Union didn’t demand my attention. These teaching examinations were very
different from our careful, slow analysis of layer after layer, muscle after
muscle, nerve after nerve of the human body. This was a place where I
could watch experts at work. They began by slicing down the midline, as I
had in Anatomy – but fearlessly. Then I saw them, with great skill, peeling
back layers of the body to uncover the organs and the cause of death. That
massive cancer, that diseased pancreas, that cerebral haemorrhage, that
occluded artery. I wanted to see them all.
University was full of opportunities: to do interesting things, meet
people, study, have fun. What a relief it was when I left home to enter this
world. Because home had changed. It had become a tense and sometimes
comfortless place.
My father, while loving and caring, could also be irascible after my
mother’s death. Very irascible. I well understand where this came from: his
adored partner had died and previously shared burdens all fell on his
shoulders. He had been left with a young son at home in need of his love
and another son who, feeling his mother’s loss acutely, had proved a
challenging teenager. On top of it all, my father longed for female company.
Despite his great grief, some time after our mother’s death he did start to
meet women. Robert and I didn’t object: our father was unhappy and one of
his early girlfriends, Lillian, was a widow who made him – actually, made
all of us – feel much better. She was warm and motherly. She laughed a lot.
Our own house was rather quiet, a place of shadows, memories and some
empty spaces, while Lillian’s was noisy and fun, with good food on the
table and friendly guests sitting all around it. And Lillian had parties.
Parties! We joined in one Christmas, giggling and fooling with the rest of
the guests as an orange was passed down the line from chin to chin.
Unfortunately, Lillian became history. Someone – and the chief suspect
was Lillian herself – started a rumour that she and our father were going to
marry. He spun on his heel and ran. By then he had turned our mother into
something of a saint and perhaps marrying someone else so soon would
have felt like less than beatification.
One summer, when we all went on a walking holiday in Devon, our
father disappeared, announcing he was looking up an old friend. We noticed
that he dressed very smartly for this old friend.
The next day he brought the friend to meet us. Her name was Joyce. She
had apparently once worked in the same office as our father, but then had
left London for reasons unspecified and retreated to her home in the southwest.
Joyce tried hard to be pleasant. She was middle-aged and nondescript and
so sugary sweet to us that she made my toes curl, but I forgave her because
I felt rather sorry for her. There was something cowed about Joyce. And
indeed, it turned out that she lived with her ill father and her bullying,
overbearing mother. Nearby she had a married niece who seemed friendly.
Apart from the niece, the inconsequential father and the horrible mother,
Joyce was alone in the world.
Her relationship with our father proved to be more than a brief holiday
reunion. She began to appear at our home for weekends. She tried to be
maternal but she just didn’t know how to take charge of teenage boys. On
the other hand, she cooked meals, and these were nothing like the meals my
father made. Once she even attempted paella, a dish of some daring in the
1960s. She also tidied up and generally brought more of a woman’s touch to
our male household.
‘We don’t need a woman’s touch,’ said Robert. He did not like her
saccharine ways and he did not like her inept attempts to fill the gaps.
Mother-shaped gaps, gaps where hugs or laughter should be, gaps in the
conversation.
I didn’t object to her but found myself retreating to friends’ houses for
much of the time when she came to stay. The fact was, she made our father
– well, if not actually happy, then at least less volatile. Because hidden
somewhere inside that kind and loving man was a volcano. It could erupt at
any time. Suddenly. Unpredictably.
When he lost his temper he screamed, he shouted, he threw things, he
terrified me. It didn’t happen very often but I always knew the volcano was
there, waiting to burst out of him in a red-faced fury, and it was so
frightening that once I even wet myself.
We sometimes went to stay near Manchester in the homely, polished
house of my maternal grandmother. One morning there, when I was about
thirteen, I as usual climbed into bed with my father for a chat and a cup of
tea. I was comfortable lolling against his pillows, my body between crisp,
linen sheets and a warm mug in my hands, when he suddenly said, ‘I’m
thinking of marrying Joyce.’
I wanted to shout, ‘No!’
I said, ‘All right.’
Maybe if he married her he would be happy. And I really did want that.
Maybe he would be less prone to mad furies. And I wanted that too.
None of us was invited to the wedding. Our father just drove down to
Devon one day and they came back married. For Joyce, it was the escape
from her unkind mother that she had dreamed of. Into another kind of jail,
maybe, because the running of the house was now placed entirely in her
hands. In fact, my father seemed to switch out of domesticity as rapidly as
he had once switched into it. Perhaps theirs had been less of a courtship
than a job interview. And the job was: housekeeper.
I do believe that Joyce tried to be a good wife. Our home certainly
became a feather-duster sort of a place. But for me now there was no
escape: Joyce was always there. I couldn’t even invite my friends home
because she just didn’t know how to receive people. But she was kind
enough, and, thankfully, she soon abandoned her inept attempts to be a
mother to me, perhaps because I made no effort to treat her like one.
My father, Joyce, Robert and I were just four people who happened to
live in the same house. Even my father distanced himself from her. I cannot
call the marriage a happy one. There would be rows and periods of icy fury.
Once, to Robert’s and my secret delight, he dumped her with her mother in
Devon. But she came back. Then there would be arguments during the day
followed by what I realize in retrospect were nocturnal rapprochements.
With residual, tooth-grindingly over-loving mornings which didn’t, of
course, last long. It was frankly baffling.
Robert went to university to study Law, a subject of which our father
greatly approved. I missed my brother but at least his absence meant there
were fewer arguments and slightly fewer eruptions.
A year later, Robert reappeared, having failed his exams. He announced
that he didn’t want to study Law anyway. He wanted to study Psychology
and Sociology.
Result: exploding father.
‘Sociology?’ he spluttered. ‘What kind of a subject is that?’
But Robert did study Sociology and then went on to a successful career
teaching it at several universities in France. Where he remained for the rest
of his working life.
Helen, whenever she visited, would point out all the things that were
missing from our home. I chose not to take any notice of my sister but, as I
grew older, I could see that she was right. Our mother was being gradually
redacted. Over the years, everything associated with her just disappeared
until no ornament, picture, photo, piece of darning, sewing basket, book,
duster or crockery remained. Poor Joyce might try to replace all these items
with something of her own but nothing she bought or did or made could
ever fill the void my mother left in that house.
By the time I departed for London, then, it sometimes felt as though Joyce
had erased my mother and, to some extent, taken my father away too. All
that changed when I was a few years into my medical training. He retired
from the council and took a job as an accountant in central London. Now
our meetings weren’t confined to my occasional visits home, with Joyce
watching on. We could meet for lunch in town, and we did, often. I had
time alone with him again.
We always went to the same restaurant in Greek Street. It was so tiny it
sometimes felt like someone’s parlour. The food was cheap and delicious
and I suspect the kitchens were less than hygienic but it didn’t matter: we
had warm, close, father–son lunches here. It was like the old days – I mean,
before Joyce. He was relaxed and affectionate and so was I, partly because
there was no risk of the volcano erupting in a public place.
Maybe he was beginning to see me as a doctor and an adult; anyway, he
was expansive. He told me that Joyce’s ‘niece’ was, in fact, her daughter,
fathered by a Canadian airman in the war. Joyce’s mother had brought the
girl up and Joyce was relegated to the role of an occasional aunt – a story
certainly not unusual in the 1940s. This great secret shame had enabled
Joyce’s mother to keep her firmly under the maternal thumb. So, when my
father appeared, the middle-aged Joyce saw him as her escape route.
It was easy now to understand why she had been unable to show the
slightest motherly feeling towards two teenage boys. She had never been
given a chance to mother her own child.
My father even described the misery of his wedding to her and how,
driving down to Devon for it, he had seriously considered crashing the car.
Not badly enough to kill himself, just enough to evade the marriage. But,
typically of him, he had decided he had better go through with it in case
Joyce – or more likely her mother – sued him for breach of promise.
I smiled at the way my father tried to be correct in everything he did, and
remembered the dictionary he had given me when I was sixteen. In the front
he had laboriously written, in a perfect copperplate hand, set inside a box
carefully drawn in ink, some lines from Alexander Pope. What were those
lines? I had learned them by heart as a teenager but now I could capture
only a fragment.
In all you speak, let Truth and Candour shine …
I determined to go back to my flat and relearn all the lines. I remembered
that the poem offered a code for proper living and correct behaviour. My
father believed in that code and wanted me to believe in it too.
At one of those lunches he told me how, after my mother’s death, he had
many times come close to committing suicide. Only the feeling that he
could not leave Robert and me stopped him. To cope, he was prescribed
Valium. Gradually he weaned himself off it by substituting alcohol to help
him sleep and relax. I never saw him drunk: he just had at the most a pint or
two of Devon cider each evening, but that seemed to make his loss and his
late, unhappy marriage more bearable.
And as well as talking openly about his own life, including his regrets
and mistakes, he told me how proud he was of the three of us: Helen the
teacher, Robert the university lecturer and me the doctor. And how proud
our mother would have been. I was deeply moved to receive this blessing,
which really felt as though it came from both parents. Even now, although
my mother and father are long dead, I can allow myself to feel touched by
those words, delivered in a shabby little restaurant in Soho. How lucky I
was to have those adult, honest conversations with that dear man.
After a year, they ended. My father was offered a lectureship in the
Department of Management at Loughborough University. This was quite an
achievement for someone who had left school at fourteen. He and Joyce
now had to sell the family home and move to another part of the country. I
did wonder what effect this would have on them but in fact it improved
their relationship considerably: no tragic first wife had left indelible
fingerprints in their Loughborough house.
Most students returned to their family home for the holidays but this was
a habit I kicked early. Summer holidays were spent working and travelling.
In 1974, driving up the coast of Italy towards Venice in a Ford Anglia with
my mates, blissfully unaware of the political upheavals we had just left
behind us in Greece, Tubular Bells on the cassette player … well, it didn’t
matter that home wasn’t there for me now that my father and Joyce had
moved away. One taproot of my life had shifted just as other roots were
forming. I had a new girlfriend and she seemed more like the future.
6
I was almost thirty before I performed my first post-mortem. There had
been the usual house jobs in different departments around the hospital, from
surgery to gynaecology, from dermatology to psychiatry. Only when these
were completed as 1980 ended did I begin to focus on my goal. It was more
than ten years since I’d started medical school and I hadn’t even reached the
first rung of the ladder to becoming a forensic pathologist, which was to
qualify as a histo- (or hospital) pathologist.
In general, pathology is a science that enables us to understand disease by
studying it in micro-detail: we name it, find how it is caused, learn how it
progresses. Everyone has some sort of contact with a path lab without really
being aware of it: all urine and blood samples are sent there, for instance.
Of course, staring at so many samples in such minute detail is not
glamorous work and, unsurprisingly, the pathology department is always
somewhere at the back of the hospital, far away from patients.
Qualifying as a hospital pathologist involves spending a huge amount of
time looking at microscope slides, studying both normal and diseased
tissue. I have lost count of the hours I spent peering at, for instance,
cancerous cells.
I found all this very tedious because I knew that, when I actually reached
my goal and became a forensic pathologist, I’d be referring such slides to
specialists and seldom looking at them myself. But I had to study this now.
There are many pathologists who will carry out post-mortems, if death is
believed to have occurred naturally, to establish the exact cause and this
would be the next part of my training – because how could I examine
suspicious, unexplained deaths and view them forensically if I couldn’t
recognize natural causes?
So, there was nothing of the criminal in my first post-mortem. The
patient had died at St George’s, Tooting, and the case had been chosen
specially for me because it was considered straightforward.
I knew I would be surrounded by senior colleagues and helpful mortuary
staff but nevertheless the butterflies in my stomach as I went to work
reminded me of my first day at school. Handfuls of rain banged against the
bus windows and then ran down them, blurring the world outside, and I
longed for the day when I could afford a good pair of shoes which would
keep my feet dry and a good coat to keep me warm. I sat huddled upstairs at
the front of the bus as it rattled and swayed to Tooting Broadway. I tried to
distract myself by rereading, yet again, the medical notes of the deceased.
I’d been given them the day before, discussed them with the more senior
trainees and almost knew them by heart already.
I had watched quite a few post-mortems at the mortuary and had half
anticipated, half dreaded the time when it would be my turn to take up the
scalpel here. Like the first Anatomy class, it was a test – no fainting,
blanching or vomiting allowed. Not because this would mean the end of my
career, but because I knew my colleagues would never let me forget it. The
same was true of mistakes. The others would correct me – and then tease
me about it endlessly. And I really did want to do well. No cutting my
fingers instead of the patient, no making holes in critical organs, no slicing
the bowel by mistake. I wanted clean cuts, decisive exposure of the relevant
organs, correct note-taking, accurate diagnosis. Plus, a bit of luck. Oh, and a
lot of courage.
Most people recoil at the smell of the mortuary. I’d say now that
mortuaries don’t smell at all, but it may be that I’m just used to it. Certainly,
in those days it seemed to me that the nose was assaulted by the whiff of
formalin, a smell as acrid as broken branches: perhaps holly in winter or an
elder bush snapped in summer. But far more penetrating.
The first sound heard on entering a mortuary is the rise and fall of almost
unfailingly friendly voices. And, believe it or not, often those voices may be
laughing, as in any office or workplace in the land. In fact, if undertakers
are coming and going, I think the word is banter, although I have never
heard jokes at the expense of the dead. In my experience, they are always
treated with the greatest respect.
The dead’s entrance is unseen by the public. It is usually next to a neat,
bright office where arrivals are carefully, no, meticulously booked in and
then taken down well-lit corridors to the banks of fridges, ten or fifteen of
them, in a solid line.
The fridges are a few metres high. Inside, each has shelving for about six
bodies. The dead slide on their trays from their metal trolleys onto their
shelf. Clang. The door is shut. Whoomp. The trolley is parked, ready for its
next use. Clatter. That is the sound of the mortuary. Clang, whoomp,
clatter.
I already knew these sounds and smells well. In fact, mortuaries were just
beginning to feel like home. But I can’t pretend that today this familiarity
brought any comfort.
‘Cup of tea, Dick?’ offered a kind assistant. I couldn’t even answer him,
let alone drink it.
The other mortuary staff were determined to treat my rite of passage as a
joke.
‘Er, Dick, make sure you get the right body, would you?’
Etc., etc. I tried to laugh but risus sardonicus – the grim, fixed smile of
strychnine poisoning – seemed to have set in.
I emerged from the changing room in my scrubs and found mortuary
wellies. They were a deathly white, which, that day, perfectly matched my
face. I wore a pair of bright yellow Marigold gloves and an apron. The kit
has changed a lot over the years but then the apron was something akin to
the aprons worn in abattoirs and butchers’ shops. The gloves were no doubt
cheap and good for washing dishes, but they protected you only from
germs, not cuts.
‘And, remember, Dick, those gloves also show you where your fingers
are …’ were the final words of helpful advice from the staff as I passed the
fridges and entered the post-mortem room.
The patient was a middle-aged woman who had been admitted to the
hospital with severe chest pains and had then died on the coronary care unit
some days later. The mortuary staff had her waiting for me on a porcelain
table. She was still wearing her shroud. Wrapping bodies really neatly in
tight sheets used to be one of the great nursing skills, like making a bed
with hospital corners, but it is seldom if ever seen now. It gave respect to
the dead but exasperated the nurses: it could take them an hour or so to
shroud a body well, only for us to simply pull the sheet off in the mortuary
to perform the post-mortem. No wonder busy ward staff abandoned all that
linen origami and started using simple paper shrouds instead.
The mortuary staff removed the shroud to reveal the body.
I stared at her. Anatomy dissection had been one thing, with its dead
bodies so long pickled and grey that it was possible to forget they had ever
been alive at all. But this was quite another thing. Here was a fresh body.
Here was a woman who, within the last twenty-four hours, was living and
breathing and talking to her family and to her doctors. According to her
notes, she had said she was determined to get better and go to her
granddaughter’s wedding in a month’s time. And then was dead within the
hour.
In fact, she looked really rather healthy and not very dead at all. I had the
uncanny feeling that she might wake up at any moment. And I was going to
cut into her pink flesh. Run a knife right down her torso and then open her.
Surgeons, of course, do just that, but for surgeons there’s a good reason, at
least in theory: they are trying to save a life or improve its quality. I could
make no such claim. At that moment, I wondered if I didn’t have more in
common with a homicidal maniac than a doctor.
My older colleagues stopped joshing and watched me closely as I carried
out my external examination of the body, looking for marks and any
indications of the cause of death.
I’d always wanted to do this. I’d worked hard to arrive at this point. But
now, suddenly, my ambition to become Keith Simpson and specialize in
forensic pathology to help solve crimes seemed a schoolboy fantasy. The
woman lying motionless on the porcelain table in front of me was the
reality. Whatever had possessed me? I must have been insane to want to do
this.
‘OK?’ asked a voice. Humour had been replaced by concern.
I took a deep breath, steeled myself, picked up the knife and placed it at
the little notch in the centre of the base of her neck between the inner ends
of the collar bones. Her skin did not resist as I pushed on the blade. I pulled
it through the midline. Firmly because I was trying to stop my hand from
shaking. Down, down, right down the body to the pubic bone.
My second cut along the same line took me through a layer of bright
yellow fat. The patient was overweight. Fat solidifies and becomes more
fixed to the skin once the body has cooled down in death and it can simply
be peeled away. Underneath is the muscle layer and beneath that is the
ribcage of the thin person who is always there inside that round body – but
hidden.
My next cut was also easy, the cut through muscle. It is hard to believe
how much like the carcases hanging at the butcher’s the human body looks
when stripped down to the bone, and how like a steak human muscle can
appear.
Now I could fold the skin sideways and outwards from the midline, as
though opening a book. Even with a breast each side, this is easy. The main
problem was to make sure my knife didn’t cut through the thin skin around
the neck: if her relatives paying their last respects saw this, it would look
shocking to them, like a stabbing. In fact, mortuary staff are highly skilled
at repairing the mistakes of junior doctors – but it would cost me a bottle of
whisky, something I could ill afford.
Once the skin, fat and muscle are pulled back it is easy to cut through and
then remove the front of the ribs. And when I had done this, there before me
were this woman’s internal organs laid out for my inspection.
Her lungs looked purple and swollen. They were flecked with soot.
‘Hmm, looks like a smoker,’ said my older colleagues, shaking their
heads in disapproval. While they hid their nicotine-stained fingers.
‘But the purple colour suggests oedema,’ added one.
‘Pulmonary oedema …’ I echoed nervously. That meant the lungs had
become waterlogged with fluid. This can happen when the heart is failing
from disease but I knew it very often happens during the actual process of
dying as the heart finally fails. Since death can be caused for one of a
thousand reasons, waterlogged lungs alone are not usually helpful for
diagnostic purposes.
I opened the sac inside which the heart nestles. It is just to the left side of
the chest.
‘No blood or excess fluid. But it looks like she’s had a massive infarct,’ I
said quickly, before anyone could tell me. About a third of the muscle at the
front of the heart was distinctly paler than the rest, indicating that it had
been deprived of its blood supply and oxygen. A myocardial infarct,
colloquially called a heart attack, is the death of heart muscle: if the patient
survives the initial damage then eventually the muscle becomes scarred. But
this heart attack was too recent for scarring.
‘What was her blood pressure the last time it was taken?’ they asked me.
‘High. 180/100.’
‘High blood pressure … oh, and she was such a big-hearted woman,’
hinted the others.
It looked like a normal heart to me.
‘Is it enlarged?’
‘Wall of the left ventricle seems a bit thick … weigh it.’
The heart weighed 510g. That’s huge.
They said, ‘What do you think?’
‘Um … lungs full of fluid. High blood pressure, left ventricle enlarged
and an infarct. One of the coronary arteries is blocked by thrombus.’
‘Yes. But which one?’
Back to Anatomy class. The anatomy of the heart. For my own personal
reasons, I’d spent a lot of time studying this organ. Its structure. Its
pathology. Its associated pathogenic mechanisms. Its arteries. Its valves.
Especially the mitral. Yes, I knew about hearts.
‘There should be a blockage in … er … the left anterior descending
artery?’
They nodded. ‘Take a look!’
I did, and there it was. A big, red, solid clot that had halted blood flow
along the artery, depriving the heart muscle of the blood and oxygen it
needed. And so, it had simply died.
What a remarkable mechanism the human seemed to me that day. As my
fear drained away I became absorbed in my work. But I still had time to
experience that sense of wonder at the body: its intricate systems, its
colours and, yes, its beauty. For blood is not just red – it is bright red. The
gall bladder is not just green, it is the green of jungle foliage. The brain is
white and grey – and that is not the grey of a November sky, it is the silvergrey of darting fish. The liver is not a dull school-uniform brown, it is the
sharp red-brown of a freshly ploughed field.
When I had finished examining each organ and they had all been
replaced in the body, the mortuary staff moved in to work their magic of
reconstruction.
‘Well done,’ one of the senior trainees said. ‘Wasn’t so bad, was it?’
It was over and I had been slow – it was well past lunchtime – but I had
done all right. I had put my feelings about older women with heart
problems to one side and had recalled my training and then conducted
myself in an entirely clinical way. As I washed afterwards I felt flushed
with relief. I was a horse that, after racing round the track for years and
years, had been nervous about facing a hurdle – and then had easily cleared
it.
The post-mortem turned out not to be the hardest job that day. Meeting
the deceased woman’s relatives was far more demanding. Given a choice, I
would have preferred not to see them at all. But they had sensibly asked for
a meeting with the pathologist to help them understand why she had died.
And that pathologist was evidently me.
I was saved by my colleagues, who did all the talking. I was simply not
up to the task, so unbearable did I find the relatives’ shock and grief. In
fact, I felt utterly helpless in the face of their emotion. Their misery seemed
to transmit itself to me, to my mind and my body, as if we were attached by
invisible wires. I don’t remember if I said anything at all: if I did, I probably
just kept repeating how very sorry I was for their loss. Mostly I am sure I
nodded while my colleagues talked.
The meeting introduced me – or, perhaps no introduction was necessary –
to the awful collision between the silent, unfeeling dead and immensity of
feeling they generate in the living. I left the room with relief, making a
mental note to avoid the bereaved at all costs and stick to the safe world
inhabited by the dead, with its facts, its measurements, its certainties. In
their universe, there was a complete absence of emotion. Not to mention its
ugly sister, pain.
7
Even at thirty, I was much better at managing strong emotion than
experiencing it. I suppose that in my boyhood I must have learned to work
hard at suppressing the anxiety caused by my mother’s illness. And then at
just carrying on, despite my grief at her loss. Our home, with its silences
and spaces, became a sort of desert where, to my relief, strong emotion did
not flourish. Although from time to time it would appear so suddenly
through my brother’s challenges or my father’s vaporizing tempers that it
seemed to be something very scary, dropped suddenly from another planet.
It was certainly very hard to believe it had been there, beneath the surface,
all along.
I would have liked life to be emotionally uneventful but by the time I
performed my first post-mortem that was certainly not the case. I returned
home from the mortuary and opened the front door to hear the wails of my
new baby son. He was oblivious to the extraordinarily powerful love and
bewilderment he stirred in his parents. And as for my wife, she showed no
sign of satisfaction with the flat emotional landscape I preferred.
Jen and I had met at the hospital when I was a student. She was the
beautiful, dark-haired nurse who mopped my brow during finals, who
entered my life with a great vitality and whose cleverness I admired. Each
day she finished most of the Times crossword at ridiculous speed – although
not quite as quickly as her father, Austin, could finish the Telegraph’s. He
had retired from a distinguished career in the Colonial Police in Uganda
after seeing service in the Indian Mounted Police and was now living on the
Isle of Man.
Jen’s parents were the beating heart of Manx society. When she took me
home for the first time I was overwhelmed by her dizzy, busy and, it
seemed to me, luxurious world. Austin presided with great charm over a
living room full of visitors. Whisky and sodas, noise and laughter, the great
old house’s lack of physical warmth was unnoticeable for the warmth of the
welcome there. The furniture and curtains were all swathes and swags. The
immense, if slightly dilapidated, kitchen smelled good. And there were
always two dogs asleep in front of the oven.
It didn’t matter if we arrived late at night; Jen’s mother, Maggie, gin-andtonic at a precarious angle in one hand, wooden spoon waving in the other,
would greet us extravagantly and ply us with fine food. She was the sort of
woman whose presence defined any party. The sort of parent my siblings
assured me my own mother had once been, although I could hardly imagine
such a thing. Viewed from the noisy whirl of Austin and Maggie’s home on
the Isle of Man, the house of my upbringing seemed a sparse, silent place.
Empty, even. I tried to remember with affection the radiogram, the
antimacassars, the swirly carpet in my childhood home. And couldn’t.
On our marriage, Jen’s kind parents helped us buy our new home in
Surrey. I had qualified as a doctor, finished my ‘house’ jobs and was just
about to start training as a pathologist. Jen was now working as a health
visitor. We couldn’t, for a while, afford a proper bed or any furniture at all,
but we were happy. Then, after a few years, we knew that the time was right
to start a family.
We were unaccustomed to adversity but here it came, making up for lost
time. Jen had a miscarriage. We were both devastated. I had no idea how to
deal with my overwhelming feelings of loss, my sense of the child that
could have been, the life that might have been lived, nor what to do with the
love that should have belonged to that baby. My pain was an enormous,
invisible thing I carried awkwardly around. Where on earth was I to put it?
This was so preoccupying that I was entirely incapable of offering Jen
enough support in her own great sadness. Was I supposed to say something?
Do something? If so, what?
I failed to say it, whatever it was, I failed to do it, whatever it was, and I
also failed to admit that I was completely out of my emotional depth. So,
when we lost the next baby, then the next, I became more and more
distressed by Jen’s apparently unassuageable grief. It was a true reflection
of my own unexpressed devastation but, rather than look at it, I confess,
with many regrets, that I turned my back. I became increasingly isolated. So
did she.
I did manage to tell her how much I loved her and how sad and confused
I was that our babies could not seem to grow larger than a cluster of cells.
Would that do?
No. She seemed to expect more from me. And she was right. Although I
still couldn’t imagine what I was supposed to offer. Just as, when a young
boy, I didn’t really know what people had wanted me to do after my
mother’s death.
Finally, when she found she was carrying yet another baby, Jen was
confined for almost the entire pregnancy to bed rest in hospital. It was not a
happy time, separating and isolating us from each other still further. Until,
at full-term, a beautiful boy, whom we named Christopher, was born one
winter’s day.
Most parents will remember the chaos of their first, longed-for arrival.
I’d been overwhelmed because there was no baby. Now I was overwhelmed
because there was a baby. And so was Jen, even though she was by now an
experienced health visitor. As for me, I was a doctor with a stint in
paediatrics behind me. But we were both taken aback by the weeping, the
sheer dissatisfaction with which our little prince responded to our efforts to
please him. And all the time we were awash with a love for him which was
so deep and passionate it shook me to the core. And his apparent lack of
appreciation of our efforts perhaps shocked us both.
When I returned home after completing my first post-mortem and opened
the door to Chris’s familiar, high-pitched wail and the sweet smell of baby
oil, I found Jen upstairs. The busy mother of our tiny son was elbow-deep
in baths and nappies, gently shushing the eternally protesting Chris.
Downstairs, her books were propped open in the living room: she’d just
started studying for an Open University degree but Chris and his yells had
seen off that plan this evening.
Every moment of Jen’s time was filled: no wonder she had forgotten it
was such a big day for me. And now that the hurdle of my first post-mortem
was receding into the distance, this racehorse began to wonder if the hurdle
had really been so high anyway.
I went upstairs to see them both. Chris looked at me and wrinkled his
face into a ball from which a smile might have emerged. Or a roar of
disapproval. Predictably, it was a roar. I took him from Jen and he wailed
some more. I rocked him, swung him, gazed at him, pulled faces at him. His
tiny features twisted themselves again into a comical but unbecoming ball.
A smile? Of course not. Out came another huge wail. How, how to stop
him?
Jen put the baby to bed while I made the evening meal. Miraculously,
Chris’s roars upstairs subsided just as the meal was ready downstairs. We
ate it, relishing the silence as much as the food. After supper, we both
studied. I was in a world of exams without end, a world Jen, on her degree
course, was just entering.
And now it’s late. I am exhausted, having spent much of last night worrying
about and preparing for today’s post-mortem. The day is over and when my
head hits the pillow I know all I want is sleep, sweet sleep. I can feel it
engulfing me. My body relaxes happily, I am slipping downstream when
suddenly … Waaaaah!
Chris. Again. God, again. He cries so much that we’re starting to suspect
that, despite being breast-fed, he might have a lactose intolerance. But what
good are all the theories in the world going to do me now? Because Chris
may be allergic to milk but he has excellent lungs and he is crying and one
of us will have to do something.
‘Your turn,’ mumbles Jen.
I get up. The house is still and cold.
I reach into the cot and scoop up Chris’s hot, stiff, angry little body. I
love him but I want to go back to sleep. I walk around the house, cradling
him in my arms. Lack of sleep is depriving me of my humanity, I am a
robot doomed to walk until the end of time with my kicking little bundle. I
know the bundle is a baby, a vulnerable baby. But I am beginning to
wonder. Is he, in fact, a tyrant? A tyrant whose sole and monstrous aim it is
to deprive me of what I crave most, sweet sleep?
Gradually, after a long, long time, gentle rocking persuades him to cry
less, to yawn more, to close his eyes. I listen to his breathing. Even. Deep.
Yes, he is asleep.
Very, very gently, stealthily, like an art thief, I traipse to the nursery and
place my tiny masterpiece oh so gently into his cot. I pull the blankets over
his sweet-smelling body. He is pliable now with drowsiness. I watch him
for a moment. He pulls a face and that may mean … I hold my breath but
all remains silent. He is dreaming. I feel something similar to joy as I creep
towards our bed. The duvet closes over me like an embrace, I shut my eyes.
And then … Waaaaaah!
What desperate parent hasn’t feared that he might shake the baby or lose his
temper and chuck the baby into the cot, or give the baby a short, sharp slap
to stop the noise? What desperate parent hasn’t been terrified by his own
pressing need for respite from the constant demands, the wearing, piercing
Waaaaah?
I knew that, although Chris was distressed, he was safe enough. I knew I
needed a few quiet moments. I shut the bedroom door on my crying son and
went downstairs into the kitchen. I shut this door behind me too. He was
still crying but the crying was distant. I covered my ears. I could no longer
hear him. I continued to cover my ears for five minutes. Breathing deeply.
Regaining my equilibrium. Then I returned to his cot. Maybe not full to the
brim with love, but certainly lovingly, and with my compassion rekindled. I
rocked him gently back to sleep.
After that, we researched neo-natal milk allergy and Jen stopped eating
and drinking dairy products. Chris became almost immediately a different
child. He slept. He even smiled. But I am grateful for all I learned from that
wailing baby. Thank you, Chris, for giving me this understanding of the
great pressure some parents face.
8
Two years later, we had another child, Anna. She was lactose-tolerant and a
much easier baby; or maybe it was we, her parents, who were easier now
we had some experience.
By the time Anna was born, my first post-mortem was far behind me and
so were many more. As soon as I’d passed the initial part of my specialist
pathology exams, I gathered speed, understanding and skill by working in
mortuaries throughout London, from Wembley to Finchley to Tooting.
I’d arrive for a morning’s work to find the dead waiting patiently for me
on a line of tables. These were not suspicious deaths. Most were believed to
have died of natural causes, which it was my job to ascertain.
Many such causes are immediately obvious. Something looking like a
blob of redcurrant jelly in the brain? That’s a stroke. Severe heart disease?
That one is rapidly settled by dissection of the coronary arteries to find
them crackly with plaque, or opening up the heart sac to discover a blocked
valve or the soft shadow of oxygen-starved heart muscle. You can see and
assess the kidneys quite quickly, also the lungs, spleen, liver, biliary tree,
gall bladder, pancreas, stomach and bowel. The heart does take a bit longer
and so do the throat, neck, trachea and bronchi.
This was a time of great change for those of us carrying out postmortems. The average length of time it took my predecessors, including my
hero Professor Simpson, to carry out one post-mortem and ascertain cause
of death where no crime was suspected might shock today’s pathologists:
often just fifteen minutes. That was partly because mortuary staff saved
time by preparing the bodies and removing the internal organs for
examination even before the pathologist arrived. That practice was still the
norm when I started. It had also been usual – and still was in places – once
the cause of death had been found, to move on to the next patient with only
a brief recording of the rest of the organs. Old-school pathologists argued
that when there was clearly a heart problem, there was no need to waste
time weighing the kidneys. And the coroners’ own pro-forma report,
published by the government, seemed to confirm this, because it was just
one page long.
Of course, this led to whispered tales of pathologists who just looked at
the heart and, if they found it at all diseased, declared heart disease the
cause of death, bothering to look no further and ignoring the fact that most
people in the Western world have some degree of atheroma (furred-up
arteries) and many may be walking around with that same degree of heart
disease. No one knew how many quick-fire pathologists were practising,
but there was a strong suspicion that their excessive diagnoses of heart
disease distorted government cause-of-death statistics.
Those days had all but passed before I became fully established. It wasn’t
just that I had been trained to examine bodies more thoroughly, but also
because inside me there was always a forensic pathologist bursting to get
out. I was keen and curious to see if a death was more suspicious than it at
first appeared. I was also anxious to establish not just the immediate cause
of death but anything relative to it.
But how hard it was for keen, young Dr Shepherd to push in the old
public mortuaries for the newfangled practices he had been taught. These
included external examination of a body before it is touched by mortuary
staff, weighing and study of each organ, samples taken for toxicology or
histology, detailed recording of findings … even just brighter lights. The
staff didn’t like any of this. Their mortuaries were often set at the back of
some dark cemetery, and the elderly staff had worked there for years and
were used to the old ways of carrying out post-mortems. I didn’t have to
listen very hard to hear mutinous mutterings wafting from their offices
about ‘new boys’ and ‘the good old days’. Sometimes, if I insisted on
showing a particular interest in a case they considered routine, they got
really annoyed and denied me my cup of tea. A cruel punishment which
seldom lasted long.
I did, however, learn something from the old-school thinking. Those
charlatans who were only too ready to name the first irregularity they
encountered as cause of death introduced young Dr Shepherd to truth’s
elasticity. Truth is based upon knowledge. So, of course, it can be
compromised by incomplete knowledge. As a doctor I sought truth through
facts. As a pathologist I was now learning that truth could be directly
affected by choices I made, by how many facts I chose to study. It was the
first step in what was to become a lifelong examination of the nature of
truth.
Carrying out large numbers of post-mortems as scrupulously as I could,
and always on the look-out for homicide, I came to know the human body
and its many weaknesses as well as I knew the Tube map – better, perhaps.
In those years, I was constantly busy: studying, teaching medical students
and, of course, performing post-mortems. Death had become a way of life,
and in the next phase of my training I had to be more or less dragged out of
mortuaries to spend more time staring at those dreaded microscope slides of
human disease.
Disconsolate, I sneaked away from the hospital path labs whenever I
could to sit in the office of my great friend and mentor, the forensic
pathologist Dr Rufus Crompton. He had helped pilot my career and now he
let me study piles of police photos, read reports and immerse myself in all
things forensic: scenes, injuries, excuses and explanations of the accused,
witness statements, everything. Just to remind myself what lay waiting for
me when I no longer had to stare at end-to-end disease slides. And,
eventually, I did begin to carry out, under supervision, post-mortems on
sudden or suspicious deaths, the sort of deaths coroners would open
inquests for and the police would investigate.
At last, sixteen years after I started my medical training, my son now
aged six and my daughter four, I qualified. I was a forensic pathologist.
That goal I had fixed on since encountering Simpson’s book as a teenager
had been achieved. But of course, it was only the beginning.
I landed my first job at Guy’s Hospital. My boss was to be Iain West, the
man who was top dog in our profession. After any homicide or disaster, his
department was the go-to place for the police, coroners or solicitors. And,
even more exciting, this was the very place where my hero, Professor Keith
Simpson, had worked.
There were four pathologists, and we were always technically ‘on call’ –
but we could pass the work round among ourselves. Less interesting cases,
that is, those which were medically or forensically straightforward, usually
went down the pecking order. And as the newly qualified arrival, I was at
the bottom of that order.
When there was no homicide to examine we were teaching and lecturing
to medical students or more professional audiences such as police or
coroners’ officers. The students were mostly in the fourth year of their
general medical training and, for many of them, this was their introduction
to a world their comfortable homes had not exposed them to before. Rapes,
murders, assaults; they lapped it up and the lecture hall overflowed. There
were students sitting in the aisles and standing at the back. They learned not
just about life but about how stupidity and inhumanity leads to fatal injury,
and I hope they learned a little about recognizing when a death is
suspicious.
It was a pleasure to hold forth to enraptured rooms, but we spent a great
deal less time lecturing about homicide than we did looking at it. Because
London seemed to be awash with murder, or at least sudden and suspicious
deaths. We had meetings in our offices, poring over photos, arguing about
cases, and then we continued the discussions in the pub, sometimes with
barristers or the police. The place just buzzed.
Of course, I treated my earliest cases, simple though they were, with
great concentration and seriousness, working with guidance from Iain and
other colleagues. But the day had to come when I went out alone to my first
homicide as a lecturer in forensic medicine at Guy’s and, because we were
so busy, it came quickly. It is hard to describe how proud I felt as I headed
towards a dull block of flats in Croydon where a body awaited me. Proud,
and not a little nervous.
It was a weekday, mid-morning. My heart was beating hard, perhaps with
the effort of trying to look like a pathologist who had been called out many
times before.
Ringed by a physical and human barrier of tape and police officers, and
beyond them press and neighbours, a young white man lay in a roadside
gutter. A Metropolitan Police photographer was already busy but paused as
I bent to examine the body.
The deceased was lying on his back and nothing more serious than a few
cuts and abrasions were visible on his face. But I knew a lot more was
happening than that because beneath his upper body was a pool of blood.
I reached out. He still felt warm to my touch. He was not yet stiff,
although his muscles were already tightening, most notably around the neck
and jaw and in the fingers.
I rolled him over. His thick jacket had a stab hole at the back. That’s
where all the blood had come from. I let his body return to its original
position.
As the photographer worked I made more notes for my post-mortem
report. In it I would have to describe the scene and what I had found there,
then I would give details of my full examination of the body at the
mortuary, and finally a conclusion about the cause of death. The last part
would, hopefully, be straightforward, since there was still blood dripping
from the stab hole in the young man’s back. But there was a lot of work to
do between now and my final conclusions.
The victim had not yet been identified, so for now he was simply
recorded as Unknown Young Caucasian Male. He looked about eighteen.
He was slim and some might describe him as handsome. I made a diagram
of what I saw, especially noting the position of bloodstains in the road and
on the adjacent pavement. I also scribbled notes about the scene, the
deceased’s clothes and the position of the body. The notes were to reemerge later in the post-mortem report as:
Rigor mortis was established around the neck and jaw but was less marked elsewhere on
the body. These findings are consistent with death occurring about 3 hours earlier.
Still trying to sound authoritative, and not as though this was my first
case, I asked the coroner’s officer to have the body removed to the
mortuary. I followed it there, where I was joined by various police officers,
including a detective superintendent. I read this in my report now with
incredulity. There is no way a ‘super’ would turn out today for a street
stabbing.
At the mortuary there were further photographs, and I wrote detailed
notes about the victim’s clothes before I even started on his body.
Jacket: heavy blood staining on the left side of the back. Gravel from roadway also
present. Three defects in the fabric. Defect one – 8cm to the left of the midline seam,
approx 21cm from the collar. 8mm in length, approx horizontal. Defect two – 12cm right
of midline seam, approx. 21cm from collar. 16mm length. Vertical. Defect three – 3.5cm
below the same approximately on the lateral midline of the right sleeve. 18mm in length.
Horizontal.
Sports shirt: blood staining on the back and left side. Three defects in the fabric …
Blood staining on the back of the waistband of the jeans, boxer shorts and underpants.
Blood splashes noted on the back of the lower half of the legs of the jeans …
When I had scribbled several pages about the clothes, we removed them,
putting each one in a separate evidence bag, which was taken and labelled
by a police officer.
Once the patient lay naked on the table for post-mortem, I could see how
extensive his wounds were. Three stab wounds in his back, one of which
had clearly been the fatal wound, and nine additional significant injuries to
the abdomen and face. In my notes are body charts – blank outlines of
bodies – and on these I drew details of the injuries, numbering them, and
then wrote notes:
Five injuries to left side of face:
(i) 3mm diameter contusion immediately above lateral margin of left eyebrow.
(ii) 10mm curved laceration with associated bruising on lateral margin of left upper
eyelid.
(iii) 20 x 22mm abrasion over lateral aspect of left zygomatic arch. Surface dried …
Lacerations are different from the clean incisions of knife wounds. In a
laceration, the skin is torn apart rather than sliced and this is caused by a
blunt weapon. Not many people regard a road or a kerb or a building as a
‘weapon’, but if a body slams against it, then its effect is that of a weapon.
In this case, I thought laceration could have been caused by the victim’s
head hitting the kerb when he fell.
Abrasions are scratches or grazes, which seldom penetrate below the
epidermis – the skin’s outer hard layer. They don’t, therefore, actually
bleed, but they can ooze blood, often as spots. They can be a feature of road
traffic accidents because they are caused by sliding over rough surfaces. Of
course, grazes are very common in life, but forensically they are interesting
because they can also occur after death. Supposing the young man’s body
had been dragged along the road: this might have caused the abrasions but it
could be difficult to tell from them if he had been dragged before or after he
was murdered.
Contusions are bruises. Damage to the small veins and arteries causes
them to break and bleed. Children have more resilient tissues so their skin
can bruise less easily than the skin of older people which has lost its
elasticity. Bruises can be deceptive, however, because their major
component is blood, and this is both fluid and biodegradable. Result:
bruises change over time and under the influence of gravity. Most notably,
they change colour. That is because, once blood is outside the confines of a
blood vessel, the body starts to break it down. Generally speaking, bruises
go from purple to yellow to green to brown. There has been much research
into dating a bruise from its colour and it would be very useful if any of the
systems devised to do this were reliable; unfortunately, none is.
It can certainly be disconcerting to find that bruises become more
prominent after death and even that ‘new’ bruises have appeared days or
even weeks later. This doesn’t mean the body has been injured at the
mortuary. It is simply a sign that red blood cells have continued to leak
from the damaged blood vessels – although pulled by gravity rather than
pushed by blood pressure.
It took a long time to write all the notes on the victim’s exterior injuries.
When I had finished I looked up, blinking. The police officers blinked back
at me. There was a pause while I remembered what to do next.
These days I wouldn’t experience the slightest shame in pausing to think
but then I so wanted to appear entirely in control that I had to pretend to
scribble notes for a moment to buy myself time. I wished the staff would
turn off Radio 1 but was too shy to ask them.
Chris de Burgh was singing about a lady in red.
I tried to concentrate. Of course. Swabs next. Of the genitalia, anus and
mouth so the scientists could look for signs of a sexual assault.
‘Any chance you could switch that racket off?’ said the super.
The staff weren’t very pleased; however, they did so, to my relief. But
now the room seemed eerily silent as I took samples of the young man’s
hair as well as clippings from his nails, which could be searched for skin or
fibres or any other debris trapped there that might link him to an assailant or
a place. At the end of the post-mortem, I would take samples of blood,
urine, tissues for histology and anything else that might be relevant.
The exhibits were all marked with my initials and a number (RTS/1). I
wrote each label with a new boy’s pride. For thirty years that unique triplet
of letters has signified my involvement in a case but on that day, the first
time I wrote them, the letters looked stark and new, like a school uniform at
the beginning of term.
Everyone in the room – the coroner’s officer and the police officers –
waited for me to start the internal examination. It is a little-known duty of
police officers to observe post-mortems: their presence is an important part
of the protocol. The super had, of course, seen quite a few in his time, but
for the young PC who also witnessed the process it was a first. He had been
looking distinctly miserable during the external examination and when I
picked up my scalpel he turned deathly pale.
‘All right, lad?’ asked the super.
The constable nodded grimly.
I tried to think of something to say to make him feel better. But I
couldn’t. I was too busy trying to look as if I had performed plenty of
forensic post-mortems entirely alone.
‘Oh, you’ll soon get used to it,’ I said airily, to hide my own nerves.
The PC swallowed. I attempted a reassuring smile but was so anxious
that my muscles felt oddly stiff and the smile may have been more of a
grimace because the PC did not return it but instead looked alarmed. Then,
as I opened the body, I became aware that the young officer did not take his
eyes off me. The way he stared at my face was so disconcerting that a
couple of my cuts wobbled slightly. I glanced up at him and saw that he
wore the fixed mask of sheer terror. Staring at my face was apparently his
method of not looking at what my hands were doing.
I would have liked to find a way to reassure and support him. But I was
so tense that I was without the resources to help. Even the experienced
super and the coroner’s officer, who had greeted each other like the veterans
of many cases together, had now stopped talking and were watching me in
deep silence. Usually the mortuary staff can be counted on to lighten the
atmosphere with a quip or a comment but today they were oddly still. Why
didn’t someone talk? Just say something? No one did. I even found myself
wishing they would switch on the radio again. Although perhaps to a
different station.
They watched as I tracked the wounds internally. When I examined the
victim’s facial wounds from the inside, the PC’s body shook suddenly and
he rushed from the room, hand over his mouth.
‘Oh-oh,’ said the super. The coroner’s officer laughed. Then we reverted
to silence.
I carried out a routine dissection of the victim’s internal systems and
organs and checked that there were no rib or other fractures. It is essential
to make sure there is no contributing natural cause of death. But the young
man proved to be in perfect health. Apart, of course, from the fact that he
was dead.
I was glad when the post-mortem ended and asked myself why the
atmosphere had been so unlike other forensic post-mortems I had attended.
I won’t say they are usually jolly affairs but there is a camaraderie, or
anyway a level of noise or discussion, which was completely absent today.
What could the problem be?
Back at the office I started to write my report.
Stab wound 1 lay 6cm to the left of the midline on the back … the upper margin of the
wound was sharply pointed: the lower margin was blunted … the wound measured 26mm
in length … The track of the wound passed between the fifth and sixth ribs of the left
hemithorax … the track then entered the left upper lobe on its posterior aspect and passed
forwards, slightly downwards and towards the midline. The track transversed the upper
lobe of the left lung and incised the left pulmonary artery … This incision was 40mm in
length and irregular … Over 1 litre of partly clotted blood was present in the left
hemithorax … There was no bruising of the skin adjacent to the wound.
So, on the inside of the body, the wound was almost twice as long as it
was externally. I included some analysis.
The route of the track through the muscles of the back was such that the left arm must
have been raised at the time of the injury. The discrepancy between the size of the
internal and external injuries suggests movement while the weapon was within the chest
cavity.
This movement of the knife could have been significant. It certainly
indicated that here was a dynamic situation, as many stabbings are. Either
the victim or his assailant might have been moving, or they could have been
still and the knife itself moved in the wound. Sometimes the significance of
such movement only emerges later, so it must be noted.
I detailed the two other stab wounds and their tracks: they had penetrated
only the muscle of the back. Then I numbered the ‘blunt’ injuries to the left
side of the face.
There were lacerations, abrasions and contusions on this body. There
were stab wounds. But, notably, no defence wounds. Classic defence
wounds are easy to spot – in a knife attack the palms and the fingers of the
hand can be slashed as a victim attempts to grasp the blade of the knife in a
desperate attempt at self-protection. This young man had no defence
wounds, but then, the main attack had been from behind.
Now for my conclusions. That’s the part of the report most people turn to
first, the part laymen – police, and relatives, and so on – should be able to
understand.
I knew the form by now. First exclude any chance that the victim died
from a naturally occurring disease. Next, say what did actually cause death
and how quickly the victim might have been expected to die. Then make
any useful comment about possible weapons or events or actions that led to
the injuries. Finally, give a medical opinion on the cause of death. This is
the formal, legal, part of the report that will – if it is accepted – appear on
the death certificate.
I wrote:
Death was not due to natural causes. Stab wound 1 … has caused haemorrhage. Death
would have occurred in a matter of minutes. The appearance of the wounds is consistent
with a weapon with a single cutting edge approximately 18 to 20mm in width at a
distance of 15 to 17cm from the tip. The weapon must have been at least 15cm in length
and most probably had a pointed tip.
Both the injuries to the right side and injuries (i) to (iv) on the left side of the face are
consistent with a blow by or against a flat surface. The possibility that they were caused
by collapse onto the roadway is unlikely but cannot be completely excluded. These
injuries appear to have been caused some time prior to injury (v) on the left side of the
face. This injury is consistent with contact with a rough surface.
Cause of death:
1a Haemorrhage
1b Stab wound to chest.
This crime, although no doubt decimating for the victim’s family, was
actually routine for a forensic pathologist. My report was not the longest or
most detailed I have ever written. But I think it took me half the night.
Once the lad had been formally identified I was able to use his name, but
apart from that certainty I experienced self-doubt over every fact as well as
over my deductions. Was I surmising too much? How sure was I that those
facial injuries weren’t caused when he fell in the road? Should I give
possible explanations for why the knife moved in the chest cavity? And did
I sound confident enough? I didn’t want, once the police had put a man in
the dock, counsel for the defence saying, ‘Tell me, Dr Shepherd: how many
stabbing post-mortems had you carried out entirely alone before this one?
What! None?’
Even though I had only just started my career, I had already understood
that court appearances could be a minefield. It was one thing to write your
post-mortem report in the office and quite another to deliver it as an expert
witness under fire in court. I’d heard many courtroom stories from older
colleagues and was both looking forward to and dreading my first
appearance in the witness box at a Crown court.
The police were soon questioning a suspect in the Croydon stabbing, a
man in his thirties who apparently was not previously known to the victim.
The young man had gone to see him at some nearby lock-up garages to buy
a cheap, probably stolen, car radio.
The police asked me to examine the suspect’s version of events and we
agreed that it would be best to do this back at the scene. And so, a couple of
days later, accompanied by the same detective superintendent himself, as
well as a detective inspector and a detective sergeant, I returned to Croydon.
We stood by a dingy row of garages. Paint peeled off their doors.
‘The accused is saying somebody else stabbed the lad after he’d left this
garage. That he must have been stabbed near to the place we found him,’
said the super.
I said, ‘There was no blood in the garage, so that could be true.’
They looked disappointed. It was not the last time in my career I would
disappoint detectives.
‘Well, we think the accused stabbed him right here. But then … there’s
no bloodstains outside the garages. Or in the road. Or anywhere but
underneath the body.’
I felt important. I felt like Simpson. Closely followed by the high-ranking
officers, I paced the route (a hundred paces) and timed it at the slow speed
expected of a dying man who had been stabbed through the lung (fifty-three
seconds) – not forgetting to move more and more slowly at the end to allow
for his increasing breathlessness and dizziness.
I turned to the detectives.
‘You may be right: he could have been stabbed at the garage and got to
the road where he was found.’
They smiled.
I wrote:
In my opinion it is entirely possible for an individual with a wound such as Injury 1 to
have travelled this distance on foot before collapsing.
The lack of bloodstains on the route may be explained by two factors. First, there
would have been little external bleeding from an upright individual following Injury 1
until the level of blood within the chest reached the site of the wound in the skin. Second,
the deceased was wearing clothing, in particular a thick jacket, which would have
absorbed a significant quantity of blood.
I need not have worried about my court appearance. The first trial
collapsed when the jury was discharged on a technicality before I could
give evidence. By the time the case came to trial again I was a veteran of so
many homicides that defence counsel had no idea this had been my very
first case.
I gave my evidence and the cross-examination went smoothly enough.
It looked clear-cut to me. I had seen the evidence against the defendant
and thought it was compelling. And three stab wounds including one deep
penetration of the victim’s lung from behind gave the tabloids a chance to
use one of their favourite phrases: ‘frenzied attack’. It was certainly used by
the prosecution too, in an attempt to disgust the jury.
I was astonished, therefore, when the defendant was acquitted. Evidently
the jury had not been convinced of his guilt beyond reasonable doubt. I
worried for a while about what had gone wrong and whether, because this
was my first case, I had somehow failed to present an effective report. Or
had I struck the wrong note with the jury? I would never know.
It happened that a couple of years later I was reading the Evening
Standard on the bus when I noticed a name which looked familiar in a court
report. I read how a slim and attractive young man of about eighteen had
been knifed by a stranger three times. One stab wound, into the left lung,
had very nearly proved fatal. By some miracle the victim had survived to
identify his assailant: in fact, he was able to reveal that the man had hung
over him and suggested that, since he was dying, a suitable last act might be
to have sex.
I remembered that very first case of mine. Same defendant. Same crime.
Different – but very similar-looking and very lucky – victim.
I knew about the defendant’s earlier murder charge. The jury, of course,
did not when they found him guilty of attempted murder.
9
My second case was another stabbing. At about nine o’clock one night I
was called to an ordinary London red-brick, terraced house, distinguishable
from all the other houses in the road only by the presence of the police
outside.
Inside was an unexpectedly ornate interior. On the banisters, blood. I
followed the trail upstairs and, just inside a bedroom door, feet nearest,
naked in a huge puddle of blood, lay a grey-haired man, face down.
I pushed the door open. The dull, patterned wallpaper darkened the room
and large, heavy, wooden furniture darkened it further. Although cluttered,
everything was in its place. The alarm clock. The radio. The framed photos.
The small TV on a mahogany chest of drawers facing the bed.
Here was the room of a man who led a well-ordered, working life. But
that well-ordered life had been extinguished and the working man was lying
awash with his own blood.
It was difficult to tread round him. His back was patterned with spatters
and rivulets of blood. There was blood on the wall. The bed was half
covered by a duvet but this did not hide the huge, deep bloodstains over the
sheets. On the floor, by an electrical socket, almost floating in blood, was a
long, wooden-handled kitchen knife.
I turned the body over with great care. I could see one gaping knife
wound in his chest. I thought there were probably more wounds, hidden by
blood.
Then I took his temperature. Since he was already naked, this was easy.
Taking a rectal temperature, especially if it involves removing clothes, can
create forensic chaos so I had already learned that quite often it is better to
get the body straight to the mortuary and take the temperature there. Now I
saw that the victim’s temperature was 26.6°C.
The detective who was watching me said, ‘So, Doc, what time did he die,
exactly?’
My heart sank. Especially at the word ‘exactly’. That’s the question
everyone asks first. That’s the question everyone thinks we can answer.
That’s the question which reveals the huge gap between the public
perception of pathologists and the truth. I blame those TV cop shows. The
fact is, it is very hard indeed for us to determine with any accuracy when a
death occurred.
The detective was waiting.
I said, ‘Well … I can’t be sure …’
Body temperature may be the best forensic indicator we have for
estimating the time of death but it is not a very reliable one. Basic physics
tells us that a hot body will cool as its heat passes into the cooler
environment. But of course, it’s not that simple. A generalization would be
that a body feels cold to touch within eight hours of death. It’s not that
simple, either. In fact, a body may not feel cold for as much as thirty-six
hours and residual metabolic activity may mean the temperature never
drops to the ambient level. Then, when decomposition is underway, the
temperature will even start to rise.
There are so many variables that can affect the rate at which we cool after
death: body temperature when death occurs, the environmental temperature,
fluctuations in the weather, central heating, open windows, the amount of
clothing on the body, the tog value of a duvet over it, the posture of the
body (as we all instinctively know, a curled position retains more heat),
bodyweight (fat is a good insulator), muscle bulk (less muscle means faster
cooling) and the age of the deceased (children have a larger surface area to
body weight and so lose heat more quickly) … a multitude of small factors
make it a mug’s game to estimate the time of death from the temperature of
a body.
Even a computer program, after taking countless variables into account,
would still not be able to give an accurate answer about the time of death. It
may suggest that death occurred between a range of times but those times
would probably be many hours apart. And still no one would expect
accuracy of more than 90 per cent.
The detective nodded wisely. He said, ‘I expect you’ll be able to tell from
the rigor mortis.’
Well, no. That’s another misconception. Rigor mortis is one of death’s
most obvious processes but it is so highly variable that it is an even less
reliable basis than body temperature for estimating the time of death. Its
speed and onset are determined by temperature. A body outside in a cold
winter may have no rigor after a week, although there can be a rapid onset
of rigor as the body warms up when it is brought into the higher
temperature of the mortuary. And there are other confounding factors. Was
the deceased exercising just prior to death? Rigor mortis will be faster due
to the lactic acid produced by physical exertion. Was death associated with
a high fever? Again, rigor will be faster. Was electrocution the cause of
death? This speeds up rigor, perhaps because of the stimulation of the
muscle cells. Did death take place in front of a warm fire? Faster rigor. In a
hot bath? Faster rigor.
Rigor mortis is actually caused by complex changes that occur once the
heart has stopped beating and the muscle cells are deprived of the oxygen
they need in order to metabolize. For years rigor was assumed to start in the
face, as anyone making a delayed attempt at mouth-to-mouth resuscitation
may recognize. We now understand that it develops uniformly throughout
the body but that it is simply most detectable in the smaller muscles first –
and these small muscles are found mainly in the jaw and around the eyes
and fingers. As a generalization, rigor can be felt in these areas about three
hours after death. It then appears to spread down the body from the head to
the legs, although in fact this is just the differential stiffening of larger and
larger muscle groups. The stiffening of the muscles generally occurs faster
than the body cools, so there is usually a period when the body is both
warm and stiff. And it doesn’t last for ever: rigor mortis wears off after a
day or so and the muscles become flaccid again.
In a temperate climate like the UK, rigor mortis may have affected all of
the muscles – ‘fully established’ rigor – within twelve hours. In hot
equatorial regions, rigor can be fully established and then disappear in just
one hour. And it may sometimes seem that certain people – the very young,
the very old or the emaciated – don’t have it at all, because they have so
little muscle bulk.
Its strength can be surprising: there are famous pictures of full rigor with
the head on one chair and feet on another and the unsupported body in
between as straight as a board. So, performing a post-mortem on a body in a
state of rigor mortis poses its own problems – unless the deceased has
obligingly died on his back with his arms by his sides.
The easiest choice is to wait for rigor to pass. Unfortunately, waiting is
not an option for the forensic pathologist helping in a homicide
investigation, where speed is of the essence.
That night I soon left the blood-filled bedroom for the mortuary. The
deceased arrived very shortly after me. His neck, arms, jaw and knees had
rigor mortis and he had actually died with one arm behind him and one
folded in front. His right leg was raised.
I needed him to lie flat for the post-mortem and so I had to break rigor.
This can require some strength. If an arm is bent I must push firmly on the
joint until I break the chemical bonds between the molecules of actin and
myosin in the cells. Once that bond is broken, the arm can be laid down flat
on the table. But sometimes if the rigor is particularly strong – for instance,
if the deceased is a muscled young man whose job involved heavy lifting –
I’ll need a mortuary assistant to help me. Breaking rigor involves putting
considerable pressure on a specific joint to loosen the muscle and it then
gives way gradually, not suddenly like a bone snapping.
In this case the patient was sixty-two years old and rigor was quite easily
broken by vigorously moving the arms backwards and forwards until they
felt loose.
At the repeated request of the police officers, I used the two unreliable
guides – body temperature and stiffness – to arrive at a range of times
between which death might have occurred. Bearing in mind that there are
any number of variables, of course. In this case, I gave an estimated time
since death of four to six hours.
‘Well done, Doc,’ said the senior detective, who was just coming into the
post-mortem room after taking a phone call. ‘The bloke who killed him says
it was about four thirty, five o’clock this afternoon.’
‘You’ve got him already?’
‘He’s just turned himself in. They were in a homosexual relationship.
Says he lost his temper.’
It was quite a serious loss of temper. There were eight stab wounds, one
of them a really gaping wound on the outside which inside had directly
penetrated the heart. So clearly do knives leave their tracks and hilts their
bruises that I was able to sketch with detailed dimensions the weapon which
had been used by the murderer. It was my first knife sketch ever based on
wound tracks and I was amazed when it exactly matched the dimensions of
the kitchen knife the police found at the scene. From now on, Shepherd was
a knife man.
In addition, although this does seem to me, looking back, like ludicrous
overenthusiasm, I thought I could establish exactly what had happened from
the wounds themselves and from the blood staining around the room. That
was, after all, what Professor Simpson would have done.
A tell-tale spattering on the wall said that the first and fatal injury was
inflicted here. The wound was in the left upper chest and its track was
slightly left to right. Classic. This told me that the killer was right-handed,
that both he and the victim had been standing and that he had used an
overarm downward thrust.
The victim then collapsed onto the left side of the bed. That was clear
from the position of the bloodstains on the sheets. And from the thin lines
of blood spattered on the ceiling above – ‘cast-off staining’, which is the
result of blood flying from the blade’s tip as the assailant raises the knife to
stab again – it was easy to deduce that the killer had stood over his victim
while stabbing him three more times.
The victim had rolled out of bed and crawled for the door. This was
evidenced from the trail of blood he had left. The final four stab wounds
were almost certainly inflicted here, by the door, where the victim had died
in a pool of blood. But the killer might have saved himself the effort: the
first thrust was fatal and after it penetrated his heart the victim had only
minutes to live. The proximity and uniformity of these four wounds, all at
the same angle, each a copy of the last, indicated that the victim was
motionless by this point and perhaps already dead. And what about the
blood I had seen smeared on the banisters? That had certainly been left by
the bloodied departing boyfriend: it was all over for the victim before he
had reached the door.
The killer had already confessed but, nevertheless, I was so proud of my
deductions that after the post-mortem I insisted on telling the detective.
‘Uh huh,’ he said, without interest.
‘Look, you can see here …’ I held out the helpful diagram I had drawn.
He did not take it.
Ever eager, I now offered to write a statement explaining my
reconstruction of events.
He blinked and looked away.
‘Nah, don’t bother, Doc. No one will read it, the bloke’s coughed.’
I was greatly disappointed. It was my first inkling that the police really
do not want me to play Sherlock Holmes. Or even Keith Simpson. My hero
was an invaluable part of the crime-solving team in the first half of the
twentieth century and was involved throughout homicide investigations at
every level: throwing theories around with high-ranking officers or counsel,
discussing clues with detectives at the scene. I’d like to do that too.
Sometimes I am bursting to tell the police exactly what my skills and
training suggest happened. But police investigation has changed. The
‘science’ of homicide has now become such a specialized business that the
many disciplines involved offer their separate facts and the police coordinate everyone’s findings and come to their own conclusions. That can
work – as long as the officers are skilled and experienced.
Next, the decision to charge or not is made by Crown Prosecution
Service lawyers. Fine. As long as the lawyers don’t struggle when
confronted by complex medical issues.
I think the system would be most effective if we could all sit down
together when a case is difficult and complicated – the police and the CPS
with the pathologist, the forensic scientists, the blood-spatter specialist, the
toxicologist, the ballistics expert – and discuss our facts together. But we
seldom do that any longer.
10
Gradually, crime scenes and post-mortems became my working life. I was
allocated easy cases to start with. They were all different but they were all
straightforward. Routine, in fact. Except that there is really nothing routine
about any crime scene, it’s just how we all try to make it seem. A
motionless body, sometimes hideously mutilated, lies at the centre of a web
of bustling, serious professionals who are all engaging fully with it while
somehow remaining detached from its horror.
And at the edges of this web, at a safe distance, is the grief and shock of
the bereaved. Pathologists know that even the most routine cases carry a
payload of trauma for someone. At that stage, I was still determined to stay
uninvolved in this trauma if I could. I did know, however, that sooner or
later there would have to be an interface with the living.
At home, there were growing children and a busy wife. I was a hands-on
father, unusual perhaps then, but I had been brought up by a hands-on father
myself and the result was that making time for my children was a bigger
priority for me than for many others of my generation.
However, I did have to learn how to leave the mortuary behind me at
home. I had to forget the sights and smells of the place, forget the homicide
victim I had just been examining and whip off the mask of clinical
detachment just as I walked in through the front door to the quotidian world
of daylight and children. Of course, that wasn’t easy. My mask was securely
fixed. And so probably I didn’t always remove it successfully. Certainly, my
wife did have a problem with that. Jen understood why I had to be
detached. But she told me scientific detachment was an approach I adopted
far too often. At home. In our marriage. Which was now under strain.
A few years earlier, Jen, who had loved being a nurse and a health visitor,
had shyly told me that she had always secretly wanted to be a doctor. She
hadn’t progressed well at school because her father held extremely
conservative, indeed colonial, views on the ‘right’ sort of jobs for women
and the education they required. She was also mildly dyslexic, which had
further affected her early educational attainment.
I had no doubts about her abilities or her intelligence, and when she told
me her ambition I promised to support her through the long years of hard
slog ahead. Now, I was very proud of how she had worked her way through
the Open University into a place at my alma mater, University College
London. She was already on her way to qualifying as a doctor.
But, of course, this put us under great pressure: of time, of money. I
earned a fair salary but nannies were expensive and, although Jen would be
earning one day, she wasn’t yet. Quite often my work clashed with her
training and then one of us had to give way. Our lives were hectic and
complicated and our relationship sagged beneath our loads. A forensic
examination of our marriage would reveal clusters of quick discussions, one
of us always rushing in as the other rushed out, communication often
limited to little more than times, dates, parents’ meetings, school sports
days, logistics. Clinical interaction of that sort.
A beautiful summer’s Sunday morning. The children, still small,
streaking into the garden like arrows as soon as I opened the back door. Me,
a fresh-faced pathologist, always at the ready to rush to a crime scene and
getting a whoosh of adrenalin if the phone rang when I was on call. Jen,
almost a doctor, always studying.
I was just about to make breakfast.
Outside, the children cried, ‘Oh no!’
The phone was ringing. At this time of the morning. It could only mean
one thing.
I considered the possibilities. Probably, because it was Sunday, someone
had simply died after a Saturday-night fight. Upstairs, I knew Jen must be
sighing. I imagined her sitting with her elbows on the desk, her head
sinking into her hands.
I did feel bad. She had been up since the crack of dawn with her books
and I had promised to look after the children today. If the phone didn’t ring.
But it had, and now Jen was about to take the shrapnel from a drunken
brawl.
A voice told me that the victim was a young Caucasian male. So, there
had almost certainly been a pub-brawl last night. Except for one thing. The
caller had identified himself as a detective chief inspector. A detective chief
inspector who said, as the call ended, that he would be waiting for me at the
mortuary with a detective chief superintendent. Top brass. At the weekend.
There must be something unusual about this case.
‘Which mortuary?’ asked Jen, getting up from her books. ‘Westminster?’
‘Swindon.’
She did a double take.
‘Swindon? In Wiltshire?’
I nodded.
She sighed. ‘See you this evening, then.’
When I arrived in Swindon, the two senior detectives were waiting, along
with a police officer and the coroner’s officer. The mortuary staff handed
me a cup of tea and the chief superintendent began.
‘Young man. Over the drink-drive limit, took a corner on a country lane
badly. His girlfriend was in the front seat and basically … well, have you
got her statement, John?’
The detective inspector nodded and opened a file. He shuffled through
some pages of typing.
‘So … the lad was working all night on Friday and he’s probably been up
all day on Saturday and he’s had a few drinks so now he’s tired and drunk
and it’s six o’clock. Good light but the road’s a bit damp. He’s picked up the
girl and he’s taking her back to his place for a cosy Saturday night. They’re
going round a bend and the van’s coming towards them and she says …’
His finger found its way down the page.
‘ “I shouted, ‘Oh my God, Michael, look out!’ and he immediately jerked
the car to the left. Michael’s side of the car hit the driver’s side of the van.
At the time of the impact I closed my eyes. When I opened them, both
vehicles were at a standstill, although there was still glass flying around
inside the car. I looked at Michael and his head was back and his eyes were
closed. I thought he was unconscious. I shook him and he sat bolt upright as
if I had just woken him up.”
‘ “I saw the other driver get out. And then this man appeared. I don’t
know where he came from. He was wearing trousers with no shirt and he
was really brown, he gave the appearance of being a labourer.” ’
The chief superintendent said, ‘He was actually working in his garden
nearby and heard the crash.’
His colleague nodded and read on.
‘ “This man asked if I was all right. Michael got out through the window
and walked to the front of the car. He pulled bits off it and kicked it and
seemed to be very angry and upset. I was upset too. I was hysterical.
Michael was kicking and throwing a paddy.”
‘ “I got out and lit a cigarette and gave one to Michael and then this man
with no shirt said, ‘Don’t light your cigarettes, there’s petrol at the back of
the car here.’ ”
‘ “Michael told him to mind his own business and the man with no shirt
said something to Michael, I didn’t hear what, which aggravated him and
then a fight started.” ’
The detective stopped reading and looked at me. They both looked at me
as if they expected me to say something.
‘What actually happened in this fight?’ I asked.
‘Michael tried to hit the man with no shirt and missed. The man hit him
back, that’s all.’
That can’t have been all. Why were they reluctant to tell me more? I
asked, ‘Well, what does the girlfriend say?’
The detective read, ‘ “The man with no shirt clenched his right fist and
hit Michael full in the face, either on his nose or his mouth. Another man,
with streaked hair, had pulled up in his car by now and he got behind
Michael and put his arms right round Michael to hold him and Michael
went a funny colour, a purply red, and passed out. The man let him sort of
fall to the floor.” ’
The detective stopped reading again. But I knew there was more.
‘Any further description?’ I prompted.
‘ “By this time, it was raining heavily. The man with no shirt started
shaking Michael quite violently to try and get some response from him. He
was saying, ‘Come on, get up!’ but Michael didn’t move and I could see he
was really hurt, he looked really poorly. The reddish purple tinge had faded.
They couldn’t revive him. An old man in a Sierra stopped and put his jacket
on him to keep him warm until the ambulances came. When my ambulance
drove away, Michael’s ambulance was still there.” ’
The chief superintendent took up the story: ‘Never recovered
consciousness. Swindon sent him to Oxford for a CT scan, then he came
back to Swindon. He died here this morning.’
He handed me some medical notes from Oxford. I looked at them and
nodded.
‘So you want to know whether you’ve got a road traffic accident on your
hands or a homicide?’
I saw them flinch at the word homicide. I wondered again why we had
the top brass here. Was the deceased famous? Especially well connected?
The superintendent said, ‘The girlfriend’s making a right fuss, saying the
bloke with no shirt killed Michael and now the family’s making a big fuss
too.’
I got up. ‘Well, let’s take a look at him.’
‘Right,’ said PC Masters as we walked into the room where the young
man’s body lay waiting for us. ‘This is Michael Ross.’
I did not recognize the name but I half expected to recognize the face.
There were cuts and bruises but I could still see that the young man had
handsome rock-star looks, with thick dark hair curling around his forehead.
However, there was nothing familiar about him.
‘How old is he?’
‘He’s twenty-four.’
I began to scribble and, when I looked up, saw that the photographer had
arrived and was waiting for me to tell him what pictures I wanted.
‘Whole body front. Then we’ll do close-ups of the face and the neck and
we’ll have those bruises on his knees, please. Oh, and this fight he got into
…’
‘The alleged fight,’ said the detective chief superintendent quickly.
‘… please photograph the hands so that we can see his knuckles.’
I scribbled:
Recent superficial abrasions, mostly vertical over the forehead, bridge of the nose and left
side of the chin. Recent punctate area of bruising (8 x 2cm) lying diagonally over the
right lower neck.
I marked Michael’s wounds on my blank body outlines then looked
closely at his teeth.
‘No sign that he was hit in the mouth,’ I said. The room seemed to rustle
a bit but when I looked up everyone was still.
There were a number of other old bruises and scars on the body, which I
noted, as well as details of Michael’s tattoos. His back seemed unmarked.
We photographed this and I then turned him over again and began the postmortem. The officers watched with stony faces. There is usually at least one
who turns green and this time, surprisingly, it was the super.
‘I’ll have to get used to it all over again; I haven’t been to one of these
for years,’ he said apologetically. ‘I’ve just come back from the fraud
squad.’
Ever since the young PC had thrown up in the first forensic post-mortem
I carried out alone, I had given a lot of thought to post-mortem revulsion, a
condition which can affect anyone whose job requires them to be present.
I asked myself why I had never, not once, shared their revulsion. Answer:
because I was so fascinated by the workings of the human body in general
and my findings in particular. I decided that if I could somehow share this
fascination with others in the room, I might be able to help them past their
horror. My theory was that, if I could involve them in the proceedings
through knowledge and understanding, then they would no longer be
helpless, shocked onlookers.
The nervous silence in which I conducted my first post-mortem and the
nausea of the PC who witnessed it could not have been sheer coincidence.
So I had determined that the next time someone present became really
upset, I’d put my plan into action by talking. Politely but lamely muttering,
‘Er … are you all right?’ as the super’s cheeks took on a greenish tinge
would not do.
Adopting what I hoped was a reassuring tone, I said, ‘As some of you
will know, I have to check the organs inside the body – not just for injuries
from the car crash, not just for damage from the subsequent brawl, but to
ascertain that there wasn’t some other, less obvious, contributing factor to
this death – like a natural disease. So, I’ll be taking a good look at all his
organs.’
The super nodded. Rather slowly. The room was silent, as though a
blanket had been thrown over it.
‘Got any music?’ I asked the mortuary staff. ‘Something classical would
be nice.’
They switched on Radio 1. I glanced at the super. Maybe the sound of
inane voices would steady his nerves. I did ask them to turn it down a bit,
though.
Cutting dead skin is like cutting the skin on a chicken joint: easy if you
use a sharp knife. The cut is hampered, if at all, not by its strength but by
the skin’s natural elasticity, and as a healthy young man Michael Ross’s
skin did have that elasticity. As I sliced through the fat which lies beneath –
in all of us to some extent, even someone as slim as Michael – I glanced up.
The super was not doing too well. Radio 1 wasn’t helping. It was time to
start talking again to test my theory that information, any information, is
soothing.
‘I’m nearly into the chest cavity now. From this stage, without impinging
on Michael’s dignity at all, you could try to forget that we are dissecting a
human. You’ve cut meat often enough and this is no different in colour or
consistency. You’ll soon see that the liver is like any liver you buy in
Sainsbury’s. The kidneys too. And this muscle I’m cutting now, well I
always think it’s a bit like a good steak.’
‘Chips, anyone?’ said the detective inspector jovially.
No one replied but the superintendent tried to nod again. As if we were
making polite conversation. However, he could not pursue this convention
by meeting my eye because his own eyes were now fixed on Michael Ross.
I continued my work. PC Masters was keen to ignore the boss’s
discomfort but the coroner’s officer seemed to take a certain amount of
pleasure in it.
‘It’s all right, he can’t feel a thing,’ he told the super cheerfully. ‘Bloody
good anaesthetic, death.’
I glanced at the super. Hmm. Start talking.
‘Of course, I’ll have to look closely at Michael’s brain and his neck.
According to the medical notes, that’s where I should expect to find damage
caused by the road traffic accident and by the fight. I mean, alleged fight.
But I can only be guided by the notes, not bound by them. I still have to
examine every organ carefully in case the doctors missed something.’
No one in the room, not even the coroner’s officer, looked as though the
prospect of examining Michael’s brain was very attractive. I decided not to
even try telling them how fascinating this would be.
Michael had been a healthy enough lad although, despite his young age, a
hard-drinking lifestyle was already having its effect. His heart was slightly
enlarged and his liver fatty, both probably signs of significant alcohol
consumption. I was sure the brain would prove the most interesting organ
and, as expected, when I lifted it out I found that it was full of blood. The
door slammed. I didn’t even have to turn round to know who had left the
room.
I asked the photographer for a picture of the brain whole, knowing that I
would have to section it soon to study its histology. I’d probably get a
colleague who was an expert in brain pathology to take a look at the slides
too. I also needed to carry out a really detailed examination of Michael’s
neck, far too detailed for this post-mortem. So I prepared a fixative in order
to transport it. The remaining police officers drew back at the intense smell
of the formalin as I turned the body over and carefully removed the neck
structures with the accompanying arteries, placing this in a mortuary bucket
to make sure I disturbed the vertebrae as little as possible.
‘Glad I drove here, I can put this in the boot,’ I said, as the mortuary
assistant carried the bucket away to seal it.
‘You never would have taken it on the train!’ exclaimed PC Masters.
‘I sometimes have to,’ I admitted. ‘It looks a bit strange but I just hope
the other passengers assume I’ve been out catching tadpoles in the country.’
Certainly, no one would ever guess what’s in the bucket. Unless they could
smell it.
‘Right then,’ said the cheerful mortuary assistant. ‘Cups of tea all round.’
I went into the locker room to change and wash. The police officers had
appropriated the mortuary’s bereavement room since it was empty, and I
found them here sitting in a circle drinking their tea. It was a quiet room,
decorated in dull shades. Along one wall was a large tank, two fish
swimming up and down it noiselessly. I don’t know why there is nearly
always a fish tank in bereavement rooms.
The chief superintendent’s cheeks were deathly pale. He was not so much
sitting in his seat as propped up by it and he was evidently disinclined to
speak, glancing at the detective inspector instead.
The detective inspector asked, ‘So, what do you think, Doc?’
‘It will take a while to get you my full report because I’ve a lot of work
to do on the brain and the neck to confirm my findings. But I can give you
an informal, off-the-record debrief if you like.’
‘Yes please,’ he said quickly, exchanging glances with the super. What
was it about this case that was causing the top brass so much concern?
‘Well, I don’t believe that the punch-up – alleged punch-up – had
anything to do with Michael Ross’s death. He was killed by the impact of
the car accident,’ I said.
The detective inspector tried to stop himself but he couldn’t. He smiled.
Even the super, still pale and barely sipping his tea, managed to pull his
mouth into an approximation of a grin.
‘Are you sure?’ the inspector asked happily. ‘How can you be sure?’
‘You can see just by looking at him that Michael screeched to a halt very
suddenly – he’s got a seat belt injury on the right side of his neck to prove
it. I believe that the sudden stop caused severe whiplash to the spine. Once
his spine was out of alignment – and according to his girlfriend he was
turning the wheel frantically at the time, which might have given his spine
an additional rotational problem – the arteries, or at least one of them,
running up the sides of the vertebrae, were ruptured. A ruptured artery
bleeds into a space around the brain: he had a sub-arachnoid haemorrhage
and that is what killed him.’
‘Whiplash. It was whiplash!’ said the inspector, beaming at the super.
‘A brain haemorrhage …’ muttered the super weakly.
‘Caused by impact!’ the detective finished for him.
I said, ‘You can get a sub-arachnoid haemorrhage for genetic reasons and
I can’t 100 per cent rule out a congenital problem yet. But it’s also caused
by trauma and in this case the haemorrhage was almost certainly a result of
the accident.’
PC Masters was looking more serious than his bosses. He had been
watching the fish swim up and down their tank.
‘Doc … how do you know the haemorrhage wasn’t caused by a trauma in
the fight; I mean, alleged fight?’
‘If the fight had caused the haemorrhage then there would have been a lot
more soft tissue injury. There’s just one bruise on the face, which might
have been a blow from a fist. I think it’s too minor to have done much but
I’ll be checking carefully when I examine the neck. Virtually all the other
facial injuries look like windscreen glass to me.’
The inspector said, ‘But Michael Ross’s family’s asking how he was able
to climb out of the car, walk about, smoke, talk, argue, fight. If he had a
brain haemorrhage. Until the other bloke, the one with no shirt, hit him.’
‘A delayed death is fairly classic for this type of haemorrhage. It can take
a few minutes, or even hours sometimes, for blood to spread from the
damaged artery up the canal to the skull. He managed to do all those things
during the lucidity period that sometimes precedes death from a subarachnoid haemorrhage.’
They all looked at one another.
‘So … you’re sure it’s nothing to do with the fight?’
‘I don’t think so. But these haemorrhages are found after both pub brawls
and road traffic accidents, so I’ll have to do a lot more tests before I can be
sure I’m right. I believe the tests will show that Michael was a dying man
from the moment of the accident and the fight made no difference.’
That’s what I thought. The timing, however, was unfortunate, since he
seemed to die at the moment the man hit him. I was going to have to work
hard to prove my theory, and be prepared to change it, since there was sure
to be a second post-mortem.
The policemen sat back in their chairs and looked at each other.
‘If you had manslaughter charges lined up against the man with no shirt,
I’d drop them now because they probably won’t stand up. I suppose you
might get him for assault,’ I offered.
They said nothing.
I asked, ‘Michael Ross had the looks and liver of a rock star: is he
famous?’
They shook their heads.
‘So … why do we have a chief superintendent and chief inspector here
on a Sunday morning?’
The super looked at me. So did the inspector. Who paused, then said,
‘Off the record, Doc, we’re here because I thought we were in a spot of
bother.’
I waited. The officers looked uncomfortable. Finally, the super spoke.
‘The man with no shirt. The one who hit Michael. He was an off-duty
police officer.’
So that was it.
‘We didn’t tell you before because we didn’t want to influence you.’
I said stiffly, ‘You wouldn’t have influenced me. Pathology tells its own
story.’ No, that sounded all wrong. Far too pompous, far too much like
someone who was occasionally unnerved by the number of versions of the
truth he was beginning to encounter. I added, ‘Even if I wanted to ignore
inconvenient truths, there’s usually a second post-mortem, so I couldn’t do
that.’
But the super was not listening. His face still deathly white and his voice
low, he said, ‘You don’t know how worried I’ve been about this one. It
would look so bad for the force and, between ourselves, a few things have
been said about that officer in the past; he loses his rag and … of course, we
didn’t want to believe he’d killed a man but his record isn’t … well anyway,
what you’ve told us is a big relief, Doc.’
‘The thing is,’ said the police constable, who clearly knew the man with
no shirt, ‘I can see how it happened. The driver, Michael Ross, he was an
idiot to smoke near the car when there was fuel all over the road, and when
Mitch told him that, he tried to argue. So Mitch had to make him stop. I can
see that.’
‘Persuading an RTA victim to behave safely is one thing, losing your rag
with him is another,’ said the inspector.
Now they knew the officer’s action had not contributed to the death, they
seemed able to discuss the matter. Even the super joined in a little.
‘Are you going to be all right?’ I asked him as I left.
He nodded but I thought his face still looked pale and drawn. I wondered
then if attending a post-mortem could actually be a traumatizing experience.
I had to ensure somehow that it wasn’t. I had done my best today. How
could I do more?
I heard the officers’ voices still debating as I walked down the corridor. I
drove home with my bucket and its strange cargo in the boot.
‘Pooh, Daddy, you’re really smelly,’ said my daughter. Anna’s never been
one to mince words. Jen fell gratefully on her books and I made supper and
then, when I was no longer on call, allowed the children to persuade me that
we should take the dog to the park.
I loaded all three into the car.
‘Anna, seat belt,’ I said.
‘No.’
‘Seat belt.’
‘Don’t like my seat belt.’
‘It’s not the law to wear a belt,’ piped up Chris. ‘Because we’re in the
back seat.’ Which in those days was true.
‘It’s the law,’ I said firmly, ‘in this car. Seat belts! Now! Or we don’t
move.’
Michael Ross was not saved by his seat belt but I had already seen many,
many fatalities that could have been prevented by wearing one. Travelling
without a seat belt is a risk I would never take.
‘I’m not going to put my seat belt on!’ Anna declared. ‘Anyway, it’s not
fair, because Dilly doesn’t have to wear a seat belt.’
Dilly wagged her tail.
I said, ‘Right. Then we don’t move.’ And to show how ready and willing
I was to sit in the car until she was safely buckled in, I got out my
cigarettes, lit one, and proceeded to puff on it until my daughter had fully
complied with my health-and-safety rules. Then we drove to the park. I
know, I know. But at least I opened the windows.
From this you will see that my attitude to risk-taking – my own and my
children’s – has always been as idiosyncratic as everyone else’s. At least
working with death has helped me recognize it can arrive most
unexpectedly and therefore I do appreciate the good things life has to offer.
So that evening I enjoyed the park, I enjoyed the general laughter while
bathing the children and I enjoyed reading them stories and then kissing
them goodnight as they snuggled into bed.
Later, Jen took a break and we sat together in the garden. As usual on a
Sunday, we were synchronizing diaries, working out how we were going to
manage our various commitments. We couldn’t afford after-hours childcare,
so each week our time had to be planned and managed.
When we had finished, we sat back. With our cigarettes. The evening was
so still that the smoke rose upwards in a straight line. It was good to relax as
the sun went down. And it was inconceivable to us that it might be possible
to relax without cigarettes. We were fully aware of the effect of this: I often
found myself looking at lungs which bore the strangely beautiful but deadly
patina of smoke inhalation. But we regarded cigarettes as an essential part
of our full and busy lives.
The next day I did some research into sub-arachnoid haemorrhages. I
found that victims often show aggression in that period when they appear to
be recovering, the period between accident and death during which Michael
Ross had started fighting. And alcohol, which frequently plays a role in
these haemorrhages, can certainly make matters worse by increasing blood
pressure and making rupture of any damaged area more likely.
It seemed Michael was a textbook case but I still had a lot of work to do.
I not only had to X-ray the whiplash injury to the spine but I had to take a
series of cross-sections of the spine’s arteries to find the resulting rupture
and show how it had caused the haemorrhage.
The chief superintendent phoned me.
‘Michael Ross’s family wants another post-mortem. They think we’re
closing ranks and they say that if we don’t charge the off-duty police officer
with manslaughter, they’ll file a civil case against him.’
‘Did you explain that I found –’
‘They weren’t interested in hearing anything from me. They’ve got their
own pathologist.’
‘That’s not unusual.’
He named the pathologist the family was consulting.
I was pleased. ‘Oh, I know him and he’s very good.’
The super sounded less pleased. ‘Wants to do his post-mortem the day
after tomorrow.’
‘I’ll be there.’
When there is a second post-mortem – and there often is, for example
lawyers defending clients on a murder charge frequently call for one – it is
normal but not required for the first pathologist to be present. I thought it
would be both useful and interesting to watch a post-mortem performed by
this esteemed colleague.
Before the second post-mortem, I examined the brain further, reassuring
myself that there was no congenital aneurysm that had caused the
haemorrhage. And I continued with my slow and careful dissection of the
vertebral arteries, photographing every step of the way, until I found the
rupture which had caused the haemorrhage. I sent specimens and photos to
the Ross family’s forensic pathologist and to another neuropathological
expert who was also coming to the second post-mortem.
Afterwards, the expert and the family’s pathologist conferred and then
wrote a detailed report that confirmed all my results. The pathologist agreed
that whiplash, caused not just by Michael’s sudden braking but his frantic
turning of the steering wheel, had dislocated his spine. This dislocation
ruptured an artery carrying blood to the brain, resulting in a haemorrhage.
He said, ‘The walking about, smoking, talking, arguing and fighting may
have accelerated the rate of haemorrhage but I doubt very much whether the
fatal outcome could have been avoided. After a few minutes, the amount of
haemorrhage became such that Mr Ross lost consciousness and from then
on the fatal outcome was inevitable.’
My post-mortem had pleased the police and the cause of death was
certainly beyond dispute when the second post-mortem concurred. But
supposing the forensic evidence had not been so clear-cut and the police
had put pressure on me to exonerate their officer? A slight adjustment in
wording at the end of a report (‘There is a possibility that …’ to ‘It is
unlikely that …’) can be enough for the Crown Prosecution Service to bring
charges or to drop them. How hard would it have been to resist such
pressure if it came from the Met, fostered by the hopes and fears of
individuals I worked with on a regular and friendly basis?
I reminded myself that I became a forensic pathologist to be a seeker of
the truth. That meant I must stand up for the truth whatever pressure I was
placed under to massage it. I see now that this is just the sort of noble
thought a keen young man of limited experience might have. I had not
worked on enough cases to know how malleable a concept truth is for some
people, nor how open to interpretation, instinct and inclination are all truths,
even those that appear to be scientific fact. Although there had already been
some intimations of truth’s elasticity. In court, for instance. But overall I
was still deluding myself that it was always possible to find a moral
pathway that everyone would recognize as clear and correct.
11
Someone had to go and speak to a CID training course, and I was pleased it
was my turn. There are a lot of police courses and officers have no choice
about attending – but some make it obvious they would rather be playing
golf or even out on the job than sitting in a lecture hall.
I was sure of getting their attention today, however, because my subject
was the human body after death. The police are seldom present when
someone dies. They inevitably arrive after the event, sometimes a long time
afterwards. This lecture was designed to help them recognize what they
might find.
I began by explaining that death is a process. And when that process,
dying, is complete, it sets off another series of processes which eventually
return us to the earth and complete the life cycle.
The screen lit up above me and the police officers stretched out their legs.
A few sipped their coffee and relaxed with the air of men settling down
with their wives to watch a David Attenborough wildlife documentary.
I didn’t want to give them too much science, so I simply said that oxygen
is vital for almost all cells. It facilitates the cells’ multitude of lifesustaining chemical reactions: this is metabolism. On death, when there is
no oxygen, muscle cells rapidly become flaccid. They may, for some hours,
still respond. To touch. Or the discharge of a dying motor neurone cell. Or
other forms of stimulation. As a result, disconcertingly, limbs may even
twitch in a lifeless body.
The eyelids may close or, more often, half-close, because muscles in the
eyelid are too flaccid to complete the movement. The response to light is
lost; however, there is a myth in some cultures, predominately Asian but
also in the West, that the eyes retain the final image they see, so exposing
the face of their killer. This was considered as a scientific possibility in
Europe in the 1870s. It was called Optography and experiments were
performed on individuals before and after execution, but without success.
Despite the lack of any scientific proof, the concept took root in the public
imagination, thanks in part to authors such as Rudyard Kipling and Jules
Verne, who used it in short stories. The idea even featured in an episode of
Doctor Who in the 1970s. Once cemented in the public psyche, it has been
very difficult to remove. Another old wives’ tale is that hair continues to
grow after death. In fact, the cells in hair follicles die with the rest of the
skin. The skin, if the deceased is Caucasian, becomes pale on death because
blood is not circulating and blood pressure is lost.
The rings of muscle that control the passage of food and liquid through
the digestive system lose their tone, which means that, depending on both
the angle of the body and the individual’s internal organs, urine may leak
out. Faeces also, but this is less common because of the structure of the
rectum.
Another common leak is that of semen. So, it is never safe for the
pathologist to assume, on finding semen outside the body, that the deceased
had sex just before he died – although he might have done. And, just
because gastric contents are found in the mouth, there can be no assumption
that vomiting was a cause of death, since regurgitation is found in about 25
per cent of post-mortems.
The police officers really did not need reminding that death can be a
messy business. They knew that bodies often leak from orifices in a way
their owners would find shameful in life. In fact, I long ago understood,
after talking to people about their end-of-life fears, that this undignified
leakage is something many find worrying about death. But I believe there is
no need for anxiety. Those of us who choose to work with the dead are nonjudgemental and respectful and I feel that worriers really won’t care about
this when life is actually draining away from them. I think they will be
entirely involved in the process of letting go and giving up their bodies.
Embarrassment is just the kind of worldly concern which I believe the
dying relinquish, often perhaps with relief.
The next process after death is cooling. I could have devoted an entire
lecture to this subject but I offered only the most general of guidelines: I
wanted the police officers to recognize how unrealistic TV movies are
about judging the time of death accurately from a body’s temperature. The
next process is the stiffening of the muscles known as rigor mortis: they
were familiar with that one. Then I showed pictures of hypostasis.
On death, blood stops circulating and its components, cells and protein,
become subject to the normal laws of gravity. Which means that the red
blood cells sink and settle in the lowest areas of the body. The tiny blood
vessels in the skin in those areas then become distended by blood. This
makes the skin initially appear pink but within five or six hours it turns a
very angry colour, bright pink with a bluish tinge. And here is the paint box
we call hypostasis.
Its alarming appearance is heightened, in Caucasians, by the great
whiteness of adjacent parts of the body, those which are pressed against a
firm surface – a bed or the floor perhaps – where the blood vessels are
squashed flat and so cannot fill. These areas stay blanched. A Caucasian
who dies lying in bed therefore has hypostasis staining most of the skin on
the back, as well as the back of the neck, thighs and lower legs – and very
white skin on the buttocks as well as white patches over the shoulders. In
darker-skinned people, hypostasis is, of course, still present, but its
appearance is much less livid.
Hypostasis does eventually disappear. But only when the blood is
dispersed by the final process after death. This process is decomposition.
Many people find the idea of decomposition repellent. It might help to
remember that this is an important natural process that completes the life
cycle of the human body and returns it to the chemical pool that is the earth.
It is hard to imagine what our world would be like without the ultimately
cleansing process of decomposition, smelly and ugly though it may seem to
the living.
There are three ways a body can decompose: by putrefaction,
mummification or adipocere, of which putrefaction is by far the most
common.
I had brought pictures and the officers seemed unaffected by those I had
shown so far. But I watched them sit up now, hoping, I guessed, they
wouldn’t have to look at putrefaction. But a putrefying body is simply one
in which the soft tissues are turning slowly to liquid. The speed of this
process of course depends on temperature. In the UK, bodies will usually
start to putrefy around three or four days after death and this will be visible
to the naked eye quickly. I showed a picture of a body and, with the pointer,
drew the officers’ attention to one small area of green discolouration just on
the right side of the lower abdomen.
‘It’s usually just there,’ I said. ‘That’s where you’ll first see putrefaction.’
Our guts are full of bacteria, which are vital for digestion. Now, in death,
those bacteria break out of the bowel and into the abdominal cavity and
then the blood vessels. The process starts at this certain point on the
abdomen, near the appendix, because the abdominal wall is very close to
the intestine here. Putrefaction can begin elsewhere, but only with good
reason: for example, if a body is lying across a heating pipe, or part of it is
in direct sunlight. Wherever it begins, by the time the green blotch is visible
on the skin, then the bacteria are running riot inside the body.
The blood vessels provide easy channels for the bacteria to spread,
causing the haemoglobin there to decompose. Visible result: the
extraordinary and beautiful fern-like pattern of the veins closest to the
surface becomes clearly etched on the skin as though tattooed in brown. It
is often evident on the arms and thighs.
I think the police officers were beginning to realize now that this was no
David Attenborough documentary. But, like every death process, this rather
beautiful stage is temporary. Gradually the pattern is lost as the skin blisters
into red and brown fluid. As the blisters burst, the skin sloughs off.
One waste product of all this bacterial activity is gas, and so now the
body begins to swell. First the genitals become bloated, followed by the
face, abdomen and breasts. Then eyes and tongue protrude as bloody liquid
is forced up from the lungs, leaking from nose and mouth. The face, with its
popping eyes and tongue, has a look of amazement.
Those officers who could look at the screen – and many chose not to –
stared back at the body I showed them with equal amazement. Swelling
bodies at this stage of decomposition become so dark that anyone finding
one can wrongly assume a skinny Caucasian was in life an overweight
black man.
Flies have a role to play in putrefaction by feasting and laying their eggs,
which turn into maggots with voracious appetites. Animals, domestic and
wild, may also make an important contribution to bodily breakdown
(outside there are rats and foxes and inside … well, yes, a starving dog
which finds itself locked in the house after a death will probably eat its
owner to survive).
Within about a week of death – depending as usual on the weather and
micro-environment – body cavities will burst and tissues will start to
liquefy. Within about a month, the soft tissues are all liquid and these will
drain off into the ground. The usual order of decomposition is first the
intestines, stomach, liver, blood and heart. Then the lungs and air passages.
Next the brain, then the kidneys and bladder. Finally the muscles. The
prostate, the uterus, the tendons and the ligaments are relatively resistant to
putrefaction and may not break down for months to leave the skeleton
stripped. I didn’t show any pictures of this final part of the process. They
looked as though they had seen enough.
A much more unusual form of decomposition in this country is
mummification. Mummified bodies are brown and dry. The skin is drawn
tightly over the skeleton so it looks shrivelled and tough like leather. This
process dries the tissues, hardening them in a way that prevents
putrefaction. It usually requires hot, desert-like conditions: bodies buried in
the sands of Egypt may even mummify spontaneously.
In the UK, mummification can happen if a thin person (the thin are more
likely to cool and desiccate quickly) dies in a very dry and draughty place –
an attic or chimney, for instance. It is rare to find a mummified body now
but not so long ago they were encountered relatively often.
‘Anyone here seen a mummified body outside the British Museum?’ I
asked my audience. A few raised their hands.
One of the older officers said, ‘Baby. Been hidden in the attic. And not
yesterday, either. Years and years ago, probably during the war they said,
because it happened a lot then.’
‘Was it a newborn?’ I asked.
He nodded. I had actually recently seen a mummified newborn myself,
and the circumstances had been the same. The bodies of newborn babies are
relatively sterile, which makes them less susceptible to putrefaction and
more likely to mummify. Those babies were generally born in secret to
single mothers in the days when this was truly shameful. Either they were
born dead, or they died at birth as the mother struggled to cope alone, or
they were actually killed but, in many cases, burial was apparently not an
option and so the body would be hidden under the floorboards or in the
attic. As social attitudes to birth outside marriage changed, these
discoveries decreased, but in the 1980s they still sometimes happened when
old ladies died and young couples bought their houses for renovation – to
find, in the loft, the tragic, long-hidden, mummified corpse of a tiny baby.
There are a few examples of adult homicides revealed years later by the
discovery of a mummified body. Most famous is a case in Wales where a
strangled woman was hidden in a cupboard for years while her family
continued to claim her pension. Once completely dried, a mummified body
can last a long time. But eventually mould forms and the dried tissues
gradually become powdery and disintegrate. The mummy very often
attracts rodents, beetles and moths, too. However, if it is recovered in time it
can very faithfully reveal through preserved bruises, abrasions or other
injuries, the cause of death.
The third process of decomposition is adipocere, a rare chemical change
in the body’s saturated fat, which hydrolyses it, stiffening and swelling it
into a waxy compound, a bit like soap. It is sometimes called ‘corpse wax’
or ‘the wax of graveyards’. Basically, the body, or part of it, is preserved,
looking as though it is a waxwork.
In the UK, the process of adipocere formation takes about six months –
although I have heard of a case just three weeks after death that presumably
was aided by the sun’s heat and the warmth of maggot infestation.
Adipocere requires damp conditions. In its early stages, when the fat is
hydrolysed into a greasy semi-fluid, the rancid smell is terrible. But, as the
process progresses, the fat becomes brittle and paler and when the
adipocere is fully formed it is grey and firm.
The phenomenon of adipocere has been documented for many years and
it can last literally centuries. Otzi, the Neolithic hunter known as the
‘Glacier Man’, whose body is on display in Bolzano in the Italian
Dolomites, was probably at least partly preserved this way. In the
eighteenth century, excavations at the Cimetière des Innocents in Paris
allegedly yielded tonnes of adipocere, and it was promptly put to use by the
city’s soap- and candle-makers. There were some famous cases in the 1970s
from Australia where the process perfectly preserved the form if not the
contents of divers’ bodies found about a year after they drowned due to
equipment failure as they explored a deep freshwater lake.
On occasions, adipocere has revealed a cause of death, perfectly
reproducing injuries like bullet holes or preserving the fat in certain organs.
In general, it is more commonly found in women, the well-nourished and
the obese, but conditions have to be right – usually the body must have been
submerged in water anaerobically or buried in a damp grave, especially if
there is no coffin and especially if the deceased is wearing natural and not
synthetic fibres. Its formation can be influenced by the season, the depth of
the grave, coffin composition, the soil and the local insect activity.
These three processes of decomposition – putrefaction, mummification
and adipocere – are not mutually exclusive. All three could, in theory, be
found in different areas of the same body, although that would be
extraordinary as each requires such different conditions. But two processes
have been found together – and putrefaction is always one of them.
Although it is common now to short-circuit the natural rotting processes I
have described by cremation, the traditional place for human remains in this
country is the cemetery. Burial tends to delay decomposition. In fact, a body
above ground is said to decompose at least four times faster than one
buried. Under ground, it probably takes two years for the soft tissues to
disappear completely. Tendons, ligaments, hair and nails will be identifiable
for some time after that. In about five years the bones are bare and
disarticulated but there are often fragments of cartilage and, if I use a highspeed saw to cut the bones of bodies that have been exhumed after five
years, there is a wisp of smoke caused by scorched protein still in the
marrow and the smell of burning organic matter – something I can also
expect from the bones of the recently dead.
The human skeleton is the last part of the body to return to the earth,
which, of course, can take a very long time: hominid bones more than 2
million years old have been found in dry parts of the world. Unless
preserved anaerobically in a bog, the damp UK climate does not keep bones
so well. And eventually, all bones must decompose. Wet soils that hold
water hasten this by leaching the calcium and other minerals away. As the
bone becomes more porous, the process of disintegration is helped by
bacteria, fungi and even plants thrusting their roots inside the cracks and
crevices and breaking up the bone more – as well as by gnawing animals.
Throughout their careers, pathologists are approached by the police to
examine bones. I asked the attendees if anyone had submitted found bones
to a pathologist and two people put up their hands. Usually just one bone is
found, sometimes a collection, and they are nearly always from animals.
But not always. All pathologists have files labelled ‘Old Bones’ and every
attempt is made to identify these finds. Some bones, like the pelvis or the
skull, tell us at a glance whether its owner was male or female. Other bones,
and particularly teeth, can tell us the age of the deceased if they were very
young or very old. Otherwise, judging age from a skeleton is not a precise
science.
For the most part, our ‘Old Bones’ files remain mysterious. Our main
task is to date the bones and discover whether this death, possibly a
criminal death, occurred in the last sixty or seventy years, in which case the
killer might still be alive. Dating is a specialist skill. Carbon-14 dating only
works to a very long time-scale but the atomic bombs of the 1940s, with
their release of strontium-90 into the atmosphere, mean it is relatively easy
to discover whether bones pre- or post-date these explosions. If they predate
the atomic era, the police are seldom interested, although archaeologists
might be.
At the end of the talk, most of the officers made a dash for the bar. There
was an orchestra of cigarette lighters clicking outside the door. One
detective did approach me, however. He was the older man who had been
involved with the case of the mummified baby.
‘Thanks for that, Doc,’ he said. ‘I’ve been haunted by that baby. And by
another one, a body which had been sitting in his armchair for almost a year
when we found him. I dream about them sometimes. But when you talk
about the science of it … well, that made me feel a bit better. I even found I
could look at the pictures you showed us today.’
This was a rare example of an officer of that era admitting to
vulnerabilities. And his words stayed with me. I resolved to redouble my
efforts to talk during post-mortems. I should not just say whatever came
into my head, but present the body in a detached, scientific way which
would help onlookers quash the very unscientific emotions they might be
feeling.
12
Very shortly after that talk came my first defence case.
So far I had only ever been called to a death by the police or the coroner.
That meant I was, almost automatically, adopted as an expert witness for
the prosecution if charges and a court case followed. Sometimes the
pathologist’s report alone will satisfy the court, sometimes a court
appearance to answer questions is required. The most searching questions,
of course, come from the defence barrister.
The defence team will usually call a forensic pathologist too, and they
probably will ask for a second post-mortem. On occasions, when a whole
group of people is accused of the crime, there may be more defence teams
ordering a third, a fourth and even more post-mortems. In these rare cases,
all the defence pathologists might perform their post-mortems
consecutively, but more usually together, observing each other’s work,
clustering around the body like moths around a lamp. Then, if we go to the
pub afterwards, it looks like a pathology convention. Each pathologist will
write a report for the prosecution or for one of the defendants, each report
will be used as evidence, each pathologist may be called as an expert
witness.
You might assume pathology is such a precise science that all reports on
the same body must be identical. This is not the case. Wounds and injuries
recorded identically may be interpreted differently. Interpretation can be
influenced by many things, especially the information supplied concerning
a case: the more information there is, the less likely that conclusions may be
erroneous.
So, as the pathologist on call one night, I might be summoned to the
scene of a crime by the police and subsequently write a detached, scientific
report based on all the evidence at my disposal. This would be used by the
Crown Prosecution Service in deciding whether or not to prosecute the
alleged killer. I’d probably then have to give my evidence in court for the
prosecution. However, if I’d just come off duty when the police’s call came,
one of my colleagues would attend the scene instead but a few weeks later I
might nevertheless find myself working on the same case – for the other
side, after a call from the defendant’s solicitor.
At the very least, defence lawyers require corroboration of the first
pathologist’s findings and report. But some defence teams are hoping for
more than that. They would like their pathologist to find an error in the
original report – which is rare, but still they hope for information which
might help exonerate their client. They at least expect a wide-ranging
review of alternative explanations or interpretations of the findings and
facts.
Defence reports are a normal part of a forensic pathologist’s workload,
but it takes a while for defence lawyers to learn a newcomer’s name, so no
defence case came my way for some time. I wasn’t sorry. I knew how hard
it can be to carry out a post-mortem on a body already examined by another
pathologist. I mean, how technically difficult: there will be an inevitable
degree of deterioration, whether the body has been frozen or just kept
refrigerated; further bruising may appear and wounds may change size;
organs are occasionally absent when they have been submitted for another
expert opinion and tissues have usually been sent away for analysis.
However, all the information the later pathologist needs should be available,
whether these are found in colleagues’ notes or in the scene-of-crime
pictures, reports or tissue samples.
There is another, more personal, reason why defence post-mortems can
be a challenge for newcomers trying to make their way in the world of
experienced forensic pathologists. That’s the fear of taking an opposing
view. Our court system thrives on these differences, but they do nothing for
relationships within the profession, particularly if you are just a newcomer
facing one of the giants of pathology.
Before accepting my first defence case, I checked with trepidation the
identity of the prosecution’s pathologist. I really hoped I wouldn’t find
myself reviewing the work of, and perhaps differing in opinion from, some
highly esteemed older colleague. To my relief, I learned that the
prosecutor’s pathologist was one of my contemporaries.
So I went to the mortuary to examine the wounds a seventeen-year-old
boy had confessed to inflicting on his father. There were twenty-seven
injuries, all of them to the face and head. The skull was broken and the
brain extensively injured. The boy’s defence team had hoped to persuade
the prosecutors that their client was mentally ill. But they had got nowhere
and now a murder trial was scheduled at the Old Bailey.
The lad’s statement was contradicted by the findings of the first
pathologist. He said he had only struck about four blows while his father
slept in bed. The pathologist insisted there had been more than twenty.
When I carried out the second post-mortem, I could not fault the
prosecution pathologist’s report, which accurately described the father’s
wounds. However, their varied nature raised some questions.
In a youthful and enthusiastic quest for truth, I set about making a replica
of the crowbar the boy had used – except that my crowbar was made of
foam. I asked how tall the defendant was and used photos of the scene to
stand at approximately the height and angle he had stood to his father. I then
spent a long time bashing a pillow with the crowbar: the pillow was
standing in for the father’s head.
After considerable study, I was able to prove that the lateral motion of the
blows would have caused the weapon to rotate on impact, and to bounce. I
wrote:
The multiplicity of injuries can be accounted for by bounce of the end of the crowbar.
The post-mortem appearances are entirely consistent with your client’s assertion that he
struck his father 4 or 5 times.
But my Simpsonian deductions never saw the light of day. A head scan
of the young man proved that he had been severely brain damaged in a car
accident several years earlier. The plea of guilty to manslaughter with
diminished responsibility was now accepted by the prosecution and the
boy’s trial was withdrawn from the Old Bailey’s list.
No courage was required to contradict the findings of the prosecution’s
pathologist for that case. But, beyond cowardice or careerism, is a deeper
problem for both defence and prosecution pathologist. Neither party can
ever – should ever – admit to being wrong. It is acceptable to admit that
there may be other possible conclusions, but, in the absence of any new
evidence, the pathologist should be sure enough of his or her view to stick
to it.
It was alarming to understand at the beginning of my career that the
pathologist is assumed to be right, whichever side he is working for. The
day I became a fully qualified forensic pathologist was the day I turned
from a not very sure trainee who still probably had a thing or two to learn,
into an expert who can never put a foot wrong. Allegedly. So, if you have
ever thrilled to the transformation of the insignificant Clark Kent into
Superman’s invincibility, imagine what a disconcerting experience this must
have been for Kent himself. Certainly, I have found the cloak of
invincibility placed upon me a heavy burden.
But why is this? Why must I now always be right when it is the human
condition to be wrong sometimes? Answer: because the adversarial nature
of our criminal justice system has no room for ‘perhaps’ or ‘maybe’ or
‘possibly’.
Even though I was determined in many areas of my life to follow the
lines of Pope my father had given me when I was a young man, and ‘speak
tho’ sure, with seeming Diffidence’, the fact was that my job did require me
to ‘speak tho’ sure with complete Confidence’. Any wavering, and
defendants might be sent down for crimes they did not commit – or freed
when they were guilty.
The greatest test of sureness comes in the witness box. Court cases
(especially at the Old Bailey, which almost reeks of seriousness and
importance), can be highly intimidating affairs. I knew that long before I
experienced it at first-hand. The collapse of one famous case because the
prosecution’s forensic pathologist had committed a minor error was a
national news story shortly before I qualified. That pathologist’s long and
distinguished career ended somewhere close to humiliation, not because his
small error was even relevant to the trial (and, I fear, not because the
defendant was innocent), but because an aggressive defence barrister had
exposed a small oversight and used it to undermine the pathologist’s
competence in the eyes of the jury.
This was disturbing, doubly so when Iain West created his own version
of the entire cross-examination for us in the pub, playing both the
insinuating barrister and the hapless pathologist for his transfixed but rather
glum colleagues.
I found myself recalling this cautionary tale during my first major dustup in court. I had been summoned by the police to a homicide and, as the
pathologist at the scene, I was a witness for the prosecution. The defence
ordered a second post-mortem from one of my former professors. He gave a
different cause of death. The defending barrister only had to glance at my
callow young face and compare it with that of the venerable professor to
know his best line of attack. The exchange (recreated here from memory
and not transcript) went something like this:
QC: Dr Shepherd, let’s be clear here, I am sure it will be of great interest and significance
to members of the jury. Can you tell me how long you have actually been practising
as a forensic pathologist?
ME: Er … well my first actual case was –
QC: By ‘practising’, I of course mean since the completion of your traineeship.
ME: Two years.
QC: Two years. I see. Are you familiar with the professor of forensic pathology who is
also giving evidence at this trial?
ME: Yes, I am.
QC: Really? How do you know him?
ME: He was my professor.
QC: Ah. I see. He taught you. Well, Dr Shepherd, you will, then, be aware that he has
been a practising forensic pathologist for forty years.
ME: I … I imagine something of that order.
QC: I can assure you that he has been practising for forty years. He taught you. Two years
ago. And he feels the cause of death you have given is incorrect. Are you sure you
have the knowledge and experience to contradict him?
ME: [Takes a large gulp.] I have examined the case fully and … er … I do not wish to …
er … revise my opinion.
QC: Are you sure about that? You are absolutely sure you know better than your eminent
professor?
ME: Um … er … naturally I respect my colleague’s … er, opinion. But … mine is
different. He did … er … train me in how to … um … form opinions.
QC: And you are not disconcerted that you have formed an opinion at such variance from
the professor you claim to respect so much?
ME: Um … no.
QC: Well, Dr Shepherd, I admire your hubris. [Shakes head with an air of tragedy and
turns to the jury.] Members of the jury, you will, of course, want to come to your
own conclusions about Dr Shepherd’s knowledge and experience. Or maybe the lack
of it.
Ouch! But I don’t think my professor had a much easier time giving his
evidence: in fact, he was forced to accept that I could be correct. Of course,
there was a great deal more evidence beyond the pathology of the case, as
the judge reminded the jury during his summing up. They then found the
defendant guilty.
I really felt myself to be under pressure giving evidence in that case:
pressure to give way on my view of the truth. Afterwards I reviewed my
findings and conclusions and I was proud that I had stuck to my
interpretation of events. Despite the battering I had received, I was still sure
my interpretation was correct. As a result, I convinced myself that the truth
was always so clear and that I would always be able to hold on to it so
easily, despite attempts to push me this way or that. I still did have a lot to
learn.
13
My children were now at school but it was well known that I was always
disappearing early from the pub after work to take care of them, sometimes
even dragging myself away from one of Iain’s spellbinding bar soliloquys,
because the nanny was going home and Jen was busy at work. My
colleagues got into the habit of saying, whenever a case concerning children
came into the office, ‘Dick loves children, give that one to Dick.’ As if
there was any similarity between helping a child of my own with reading
homework and examining someone else’s dead child. No, the truth was that
many people avoided child cases if they could.
It did not take me long to learn why. For there is nothing more likely to
bring great joy to the private life of the forensic pathologist as a new baby
and nothing so likely to bring great misery to his professional life. Fact: it is
quite easy to kill a baby, especially a newborn, without anyone being able to
prove it. Fact: sometimes it looks as though someone has killed a baby
when the death is entirely natural.
A baby case came in, everyone looked at me and I soon found myself at a
mortuary on the edge of London. The deceased was a newborn girl found in
a black bin bag washed up at the edge of a lake at a beauty spot. The
umbilical cord and placenta were still attached.
My examination told me that the baby had certainly been born at full
term. She was fully developed, covered in the waxy vernix of the newborn,
weighed over 7lb and seemed to have been entirely healthy with no
anatomical abnormalities or diseases that could have caused her to die.
The police explained that the mother had been easily located. She was
insisting that the baby had been stillborn. The police doubted her word.
They wanted to charge her. In fact, they wanted to charge her not with
infanticide but with murder. And so we found ourselves in the middle of a
really difficult area of both the law and pathology. No wonder the office had
been so pleased to hand me this case.
Infanticide is manslaughter, and so carries a far lighter sentence than
murder. It was introduced in 1922 for the prosecution of mothers who killed
newborns under thirty-five days old. Back then, killing a baby was not
considered such a terrible offence as killing an adult. It was believed that no
baby could suffer like an adult victim and no baby would be missed like an
adult member of the family. And it was well understood that one possible
motive was shame at illegitimacy.
We might discount this thinking today, but one important aspect of the
1922 Act has endured. The law recognized that there could be a
‘disturbance of a mother’s mind which can result from giving birth’,
something which today we call postnatal depression – or its even more
serious sister, puerperal psychosis. This view was retained by a new
Infanticide Act in 1938. From then until now, a mother who kills a baby
under twelve months old can be charged with infanticide if it can be shown
that ‘the balance of mind is disturbed by the effects of childbirth or
lactation’.
The reform of this law has been debated many times. The Royal College
of Psychiatrists recently suggested the definition of infanticide should be
broadened to recognize that a baby’s birth may have created overwhelming
stress, for instance the stress of an extra member of the household where the
family is struggling in poverty. Others thought that infanticide was a charge
that should equally apply to fathers, and some that it should apply where the
victim was under two years old, not one year. Some pointed to a lack of
medical evidence to justify the reference to breastfeeding affecting the
balance of a mother’s mind.
In fact, after reviewing all these suggestions, amendments have been
minimal. But the unchanging law masks changing attitudes, including the
recognition that children and babies have rights.
As I examined that baby found at the lakeside, the first question I had to
ask myself was not whether this was murder or manslaughter but whether
the baby had died at all. Because a baby who has never lived cannot die.
Nor be killed. And, in the legal sense, a child in the womb has not lived.
Anti-abortionists may disagree, but that is the current practicality of the law.
The underlying question for the pathologist in such circumstances is: when
is a person not a person? And this is important because a person has rights,
legal rights to inheritance or title, and human rights. Kill a person and you
can be charged with murder or manslaughter. But not if the person never
actually lived.
Under English law, a dead newborn is assumed to have been stillborn. If
murder or manslaughter is suspected, it is up to the pathologist for the
prosecution to prove that the baby lived long enough to establish a separate
existence.
One breath is all it takes. Or a movement. Or a pulsation of the umbilical
cord which indicates a heartbeat. And the baby must be completely out of
the mother’s body: a baby born head first, as most are, can theoretically
take breaths but still die before the rest of the body is free of the mother. In
that case, there has been no separate existence and the baby cannot have
been killed.
A baby who has died in the womb in the last day or so of the pregnancy
will show the early signs of decomposition, and these are distinctive (for
instance, the colour of a dead Caucasian child will probably be pinkybrown). If the baby has been dead for a longer period, diagnosis is even
easier: the skull may have collapsed and the skull bones might be
overlapping, for instance. But if the baby died less than a day before birth
or, much more commonly, during the process of birth, there is of course no
decomposition.
If there has been resuscitation, mouth-to-mouth or chest compression, the
effects can be marked on a tiny body and this can confuse things still
further. A final problem is that the bodies of newborn babies who are killed
or born dead are, for complex psychological reasons, often concealed. By
the time they are found and the pathologist gets to work, it can be
impossible to establish the cause of death, let alone whether the baby ever
had a separate existence.
This little girl in the bin bag had been found soon enough to prevent
decomposition and too late for resuscitation, so her body was unmarked. So
now I had to try to establish whether she had actually breathed in this world
or not.
I did carry out the centuries-old flotation test knowing that it had really
lost credibility – but fearing I would be criticized if I did not. The belief that
if the lungs of a dead newborn float then the baby must have breathed and
had a separate existence has been proven a myth. A lung that sinks when
placed in water does point to the possibility that the baby has been stillborn
because it suggests that the baby did not breathe sufficiently to expand the
lungs. But the opposite is even less likely to be true: if the lung floats, that
does not mean the child must have breathed spontaneously. It is now known
that the lungs of many stillborn babies will float, particularly where there
are gases due to early decomposition if the baby has died a day or two
before birth.
I also examined microscopically the lungs’ tiny air sacs, the alveoli. For
what it was worth, the child’s lungs floated. Macroscopic and microscopic
appearances did strongly suggest that there had been a period of separate
existence.
My next job was to read the statements I had been given and see how
they related to the baby I had examined. The key statement came from a
barman who lived and worked at the same hotel as the baby’s twenty-oneyear-old mother. It began:
When Mandy came to work at the hotel as assistant manager she seemed all right except
that I only had to look at her to think she was pregnant. I have two sisters with children
and she certainly looked pregnant to me. This was common knowledge among the bar
staff but Mandy always denied it.
The staff all stayed in one part of the hotel and the barman’s room was by
the fire escape at the back. He woke very early one morning to the sound of
a baby crying outside his door. He looked out of his window
… and saw the back of Mandy, maybe fifty yards away, going through the gate towards
the woods. It was definitely Mandy. I’m not sure what she was wearing and I couldn’t say
whether she was carrying anything. I wondered where she was going. I started to think
about it. I thought she might have a problem so I got dressed and decided to go out and
join her. I know people in this trade do sometimes get pissed off and just want to talk.
It took me a few minutes to get dressed. I went down the fire escape and out through
the gate into the woods. I walked towards the lake and I saw Mandy walking back from
the direction of the lake.
She said, ‘What are you doing out here?’
She seemed OK to me as far as I could ascertain. She was fully dressed but for the life
of me I can’t say what she was wearing. She basically said she was pissed off with
everything and everybody. She didn’t specify. I sat down with her on a seat facing the
lake and we just spoke in general about my girlfriend and the band I play with and other
things. We talked about the mist rising off the water. I didn’t suspect anything was
particularly wrong. She seemed to be her normal self. The only unusual thing she said
was, ‘I’ve come on tonight and I’ve had blood clots.’
I never pursued the point but it seemed a funny thing for her to say to me. We must
have talked for about forty-five minutes and I never suspected anything. I never thought
any more about the baby I’d heard crying.
We went back to the hotel and she came into my room for a cigarette, then she left. I
never noticed anything unusual about her at all. I then went back to bed and had a sleep.
Later that day the staff remarked to each other that Mandy looked
slimmer. And the next afternoon, there was a commotion. According to the
barman’s statement:
I was working in the bar when a woman came in asking for the phone, she had a dog with
her. A bit later another member of staff came in, Roger, and he said, ‘The Old Bill are
over by the lake, a baby’s been found.’
When he said this I really came over ill. I remembered hearing this baby cry the
previous morning and seeing Mandy by the lake and I suddenly thought it all fitted. I
didn’t know what to do. I said to Roger, ‘I know who it is.’
He said, ‘Mandy?’
And I said, ‘Yes.’
That is fairly convincing evidence from a witness that the baby had lived,
and perhaps lived for a good few minutes if the mother had time to give
birth in the hotel toilet (evidence of this was soon found) and then get
dressed and walk out of the hotel with her crying baby to dispose of it. And
that fitted with the pathological evidence from the lungs that the baby had
lived after birth.
But could we say for sure that she had killed her baby – and, if so, how?
This was an upsetting case for everyone, not least because of the cool
way the mother had given birth, disposed of her daughter – stillborn or not
– and then returned to work that day pretending nothing was wrong. Today
she might be regarded as a tragic figure. Thirty years ago, many of those
involved in the case saw her as an unnatural, calculating baby-killer. She
showed no remorse, saying the baby had been born dead – and she showed
no sadness either. The police and Crown Prosecution Service remained
adamant that the charge should be murder.
I was very confident from all the evidence that the baby had lived. But
then, how had she died? I could not find evidence on the child’s body of
violence or trauma and no incontrovertible indication of asphyxiation. A
very detailed laboratory analysis of the stomach confirmed the baby had
taken in water from the lake, but not enough to indicate drowning: it could
have got there passively, by non-sinister means.
I gave as cause of death ‘1a: Lack of care’.
The Crown Prosecution Service pressed ahead with its murder charge but
they were dismayed by my findings. They wanted me to say that the mother
had taken more active steps to end the child’s life.
On the other hand, my report delighted the defence solicitor, who wrote
to the CPS:
We would invite you to consider whether the charge of murder should now be withdrawn,
bearing in mind the apparent lack of an alleged act on the part of our client which led to
the death of the baby … Your pathologist says that death was caused shortly after birth
due to an omission on the part of our client. Clearly a charge of murder would not
therefore be appropriate … [indeed] we invite you to consider that a charge of
manslaughter [i.e. infanticide] would not succeed as you would not be able to show that
the death of the baby was the result of a grossly negligent omission … simple lack of care
is not enough [to prove this charge]. Our client told the police how she laid the baby
down and rocked it but thought that it was dead.
It is true that the Crown Prosecution Service, for a murder case, had to
prove a wilful act of omission: that is, the deliberate failure to provide
normal care at birth, such as cutting the cord and keeping the baby warm
and fed. It is very hard, in the case of a frightened, inexperienced teenage
girl, to prove that not doing these things is wilful. In fact, Mandy was not a
teenager and she was not inexperienced, as we were to find out, but, for a
while at least, the prosecutors were miserable.
‘I am particularly concerned,’ their letter to me began, ‘regarding the
vague nature of your report … I am not medically trained but I have a
medical dictionary and these are some of the points which have occurred to
me …’
She listed six detailed points about the baby’s death.
Medical dictionaries were the scourge of doctors then – as the internet is
now. Sometimes I wonder why I bothered with sixteen years of training
when all I needed to do was buy a medical dictionary or learn how to
Google. But if a dictionary gave that lawyer a way into my work, then let
her consult it: I am only too happy to enlarge on my findings and rarely am
given a chance to discuss a case.
In response to these written questions from the CPS, I made a further
statement, giving detailed answers to each of her points to show that most
of her concerns, like meconium, were routinely found in newborns and
none of them meant the baby had necessarily been asphyxiated. I stuck to
my view that lack of care had caused the child’s death. Although the mother
might have actively killed the child, we – I – couldn’t prove it.
The CPS were not at all satisfied. At a case conference with counsel, I
was put under great pressure to step closer to the prosecution’s case than the
pathology of the child really allowed. I did not give in. Afterwards, I sent
further notes answering points they had raised:
It is not possible to define exactly the passage of time necessary to cause suffocation by
blocking the airways, however in a newborn baby the minimum time is unlikely to be
more than 15–30 seconds. There were no injuries to the mouth or nose to positively
confirm that pressure had been applied to those areas, however such injuries are not
always present in cases of suffocation. Their absence, while preventing a positive
conclusion, is not completely inconsistent with suffocation having occurred.
I have given the survival period of less than fifteen minutes. I think it is unlikely that
the period of survival was as short as one or two minutes, only because the changes in the
lungs are well-established. I think it unlikely or very unlikely that a single breath would
have resulted in the degree of changes I noted in the lungs. It is certainly the common
event that a child will cry after birth but, like all things in medicine, it is not absolute and
there is individual variation. The act of crying most certainly assists in the expansion of
the lungs.
It is not possible from my examination of the baby to make any specific comment
concerning the well-being of the mother. There are, however, no features present on the
child to suggest that this may have been an unusually difficult or traumatic delivery.
It is very difficult to define lack of care. In my opinion, minimum care of a child
immediately after birth is to wrap it in some sort of material to prevent the baby from
cooling. Any other form of care may need previous experience rather than professional
training. The minimum care of placing a child in a towel will, very markedly, at least
reduce the risk of hypothermia. Hypothermia could have caused the death of this child
within fifteen minutes. A child has a very large surface area from which to lose heat and
this surface area would have been wet as a result of fluids from delivery, once again
increasing heat loss. The cooler the environment in which the child lies, the greater the
heat loss.
The pathological features of a huge number of possible reasons for the child’s death,
including hypothermia, drowning and asphyxiation, may not be present in a child when
one would expect them to be in an adult. I cannot exclude or confirm any of them.
The disappointed prosecution still pressed ahead, reluctantly conceding
to the lesser charge of infanticide. They also threw in that ancient but rarely
brought charge, concealment of a baby.
Mandy was tried at the Old Bailey. Prosecuting counsel was quoted in
newspaper reports telling the jury:
When she became pregnant she decided to conceal her pregnancy and the existence of the
baby once it was born. She followed the plan through to its logical conclusion by leaving,
and allowing or causing, the child to die and disposing of the body by tying it in a black
refuse bag. She continued to lie after birth by joining in with the general disapproval
expressed when the body was found.
The court was then told that Mandy had initially claimed the pregnancy
was a result of a rape but then changed her story. In fact, she had given birth
before, on her mother’s lavatory two years previously, when the child had
been offered for adoption. A second unwanted pregnancy soon afterwards
was terminated.
The jury found her guilty of infanticide. The judge thundered, ‘You and
only you had responsibility for that young child and you failed her …’ But
he added, ‘It is clear that you were not at that time entirely responsible for
what you did.’
She was sentenced to two years on probation and ordered to undergo one
year of psychiatric treatment. There was a sense of disappointment in the
prosecuting team, as everyone knew her sentence would have been harsher
if she had been found guilty of murder. For myself, I had no regrets. It
would have been unbearable if she had been tried for murder on the basis of
evidence produced under pressure but against my conscience.
14
Soon afterwards I found myself learning more about truth – although I was
now in a very different situation. The prosecution team and I were entirely
in accord over this case, and by the time we were in court we all felt
confident that we had uncovered the truth.
It was another Sunday morning call-out. More guilt as Jen had to put
aside her work to care for the children, meaning she would have to study
through the night to make up for lost time. Jen must have asked herself why
the dead seemed so much more important in our house than the living and,
looking back, I don’t blame her. The children were older now and a little
more independent, but conflicting demands were causing frequent clashes
between their parents. However, our division of labour was clear-cut to me:
as the breadwinner, my work had to take priority. Only now can I see from
Jen’s point of view how frustrating this must have been and how much I
must have infuriated her. After all, she wasn’t studying for studying’s sake
but so that one day she would be a doctor and a joint contributor to
household income. I entirely failed to appreciate that: I was so workimmersed and so focused on how to make our hectic lives functional that I
couldn’t, or wouldn’t, understand her dissatisfaction.
I set off that sunny morning towards central London, feeling more
excited than guilty. I adored my children and a Sunday spent looking after
them would be many things: fun, demanding, tiring, fulfilling. But – and
this now seems perverse and scarcely believable to me – those pleasures
could not compete with the possible intellectual engagement of an
interesting post-mortem. Yes, even though I was already a few years into
the job, I still could not contain my excitement at each new case that came
my way. The stardust that the pages of Keith Simpson’s book had sprinkled
in my young eyes so long ago was still there. Let other hearts sink on
nearing Westminster mortuary: mine beat faster as I thought of the situation,
the story, the puzzle of the body awaiting me. And this was despite the fact
that I knew the chances were, on a Sunday morning, that I’d be dealing yet
again with the consequences of another Saturday night pub brawl.
Westminster mortuary is hidden behind the coroner’s court in Horseferry
Road in central London, but these are not among that area’s famous
buildings. In fact, tourists heading towards the Tate hardly notice the
beautiful old red-brick court on the corner and they are completely unaware
of the mortuary behind it. Like so many institutions of death, it is discreet
enough to oblige those who don’t wish to be reminded of the inevitable.
In fact, the mortuary had then not long been rebuilt and was the most
modern in the UK. Its public entrance was glassy, its lighting was bright, its
offices spick and span and its areas for grieving relatives elegantly painted
in pastel shades. But, despite all that glass and newness, arriving here on a
weekend marked a transition. From family life back across the taboo, into a
darker world where, albeit it with jolly staff and warm rooms, death is a
way of life.
The smell of the mortuary, death’s perfume, in my nostrils, I greeted the
small crowd waiting for me: the mortuary staff, a SOCO (scenes of crime
officer), a young police constable and two detectives. There was also a
police photographer who seemed often to be on call when I was and who
was becoming a familiar face.
The kettle on, we went into the tiny staff tea room. It was empty on a
Sunday. Detective Inspector Fox spoke first.
‘Now then, the deceased is a young bloke. Saturday night, a lot of booze,
a bit of cannabis …’
So, it was a typical Sunday morning job after all. My heart sank. I’d
rather be at home with the kids.
‘Had a bit of a run-in with …’
Not the first time I’d heard this one either. A knife, bottle, fist?
‘… his girlfriend, and …’
She’d knifed him then, almost certainly. The detective hesitated.
‘And so she strangled him.’
I stared at him. That was not the ending I’d expected. Female stranglers
are extremely rare, almost non-existent. Looking back now, tens of
thousands of post-mortems later, I believe there is no other female strangler
in my files.
‘Has she confessed?’ I asked.
‘Turned up outside the police station in the middle of the night with
blood, scratches, shirt torn, crying her eyes out. We called an ambulance.
She said she’d had a fight with the boyfriend and thought she’d hurt him.’
‘How long before?’
‘Apparently only minutes. We rushed over there, no pulse, did everything
we could, got him in the ambulance and kept trying but it was no good.
When we told her he was dead she was … well, it was terrible.’
He looked upset. He’d obviously been in the Met a long time and I
wondered why this case was affecting him so much.
‘I was interviewing her for hours and she never changed her story. Selfdefence. And … well … she’s a sweet young thing.’
His colleague agreed. ‘Yeah. Theresa Lazenby, her name is. Nice little
face. In tears most of the time.’
The detective inspector nodded. ‘Seems such a good kid, it’s hard to
believe she could have … but he was trying to kill her and she had to save
her own skin.’
I know how the living send out signals which are designed to appeal to
our hearts. I know how easily I personally respond to these signals. The
girlfriend’s remorse had clearly rubbed off on the detectives and, although
she had confessed to a terrible crime, she had somehow won their
sympathy. I felt relieved then that the dead can send out no such subtle
appeals to our emotions. They can only tell the unadorned truth.
The mortuary assistant handed me a mug of tea and I threw it back and
went to the lockers to put on my scrubs, apron and mortuary wellies. As we
made our way from the public area to the busy, functional working area, the
clangs and clatters of the trolleys grew loud and the smell increased. I
glanced at the men around me. For the SOCO this was routine. And the
detectives had seen it all before and were nonchalant, or at least keen to
appear nonchalant. However, as we passed the bank of fridges and line of
trolleys waiting by them, I could see that the young police officer was
nervous. PC Northern had not eaten the biscuit the staff had given him with
his tea and now his face was pale and hollow. Just before we went through
the footbath into the room where forensic post-mortems take place, he
blurted out, ‘It’s my first PM!’
By now my management of onlookers was improving. I could not forget
my failure to alleviate the misery of the police officer at that first postmortem: it seemed to me that he had picked up my tension and this had
greatly added to his distress. Since then I had worked hard to appear
relaxed. I remembered the Michael Ross post-mortem, where a
superintendent had barely been able to control himself in front of very
junior staff. After that, I had determined that, when I performed a postmortem, no one should ever leave the mortuary traumatized.
My only weapon was communication.
‘When we look at a dead body,’ I told PC Northern, ‘we never forget that
they were a person once, that there are grieving relatives, that the deceased
and their family deserve respect. We’re going to help all of them today by
trying to find out exactly what happened. We’re looking for evidence, we
want to help the dead man tell us his story. It’s important for all the grieving
people that we put aside our own feelings and do a good job for them. So,
without uttering a word, the body we’re examining today will be our
witness and our teacher.’
PC Northern nodded glumly.
I used the kindest, most reassuring tone I could muster. ‘Don’t worry, I’ll
talk you through it. It won’t be nearly as bad as you think if I explain what
I’m doing.’
The worldly wise detective sergeant said, ‘You get used to it.’
The detective inspector was determined to be macho: ‘Listen, the people
in the fridges here are gone, not at home, lad. So just pull yourself together.’
We stepped into the brightly lit room where the body was lying naked,
wrapped in a plastic sheet on a metal table.
‘He’s been ID-ed,’ said the SOCO as I opened the sheet.
‘What’s his name?’
He knew the name but he passed the question to the young policeman,
who was glad to stop staring at the body and shuffle busily through his
notes.
‘Er, Anthony Pearson. Aged, er, twenty-two.’
Anthony Pearson had a mop of blond hair and well-defined features. His
eyes were shut. The dead usually look peaceful and without facial
expression. Was there a hint of anger about him? Not because he had
necessarily died angry but because, out of habit or bad luck, his features fell
that way.
I thought then that he was mildly obese – but norms have changed so
much that today I would simply describe him as stocky. There were large
tattoos as well as bruises on both arms and old scars across his wrists that
hinted at a troubled life. The much more recent incisions, defined by lines
of blood running across his forearms, confirmed it. Defibrillation marks on
his chest were evidence of the resuscitation attempts the officer had
described.
Most noticeable of all was his neck. Beneath it the hospital sheet was
heavily bloodstained. Across it was a thick, ragged line of blood that had
dried after trickling from the side of his mouth.
I nodded to the police photographer, paparazzo to the dead. He lifted his
large camera and organized the correct siting of the two large flash guns,
the sort often seen outside film premieres. Snap–flash!
‘OK, that’s the whole body, Doc.’
‘Close-ups of the neck now, please,’ I said.
I was already taking notes on my pro-forma sheets. The ligature mark is a
vital piece of evidence and, of course, it can indicate the type of material
used. If the ligature is wire, electric cable, string or thin cord then the mark
is clear-cut and deep with sharply defined edges. But this mark was highly
irregular. Ragged, even. She must have used something soft. Fabric?
Perhaps a scarf?
For the photographer’s next shot, I rapidly placed a ruler across
Anthony’s throat so that the photos would confirm the measurements in my
report. Snap–flash!
I made a note:
Contused and abraded irregular ligature mark across the front of the neck extending from
the right angle of the jaw to 2cm lateral to the left angle of the jaw. Level with Adam’s
apple. Deepest bruising either side of Adam’s apple …
I checked very carefully all around the neck wound for other relevant
marks. I’d seen cases of strangulation where the line of the ligature was
surrounded by scratches or bruises, indicating either that the victim was
trying to pull the ligature off or, where the ligature mark overlay groups of
bruises, that the assailant had attempted manual strangulation before
grabbing the ligature. But there was nothing like that here.
‘She said she used his tie,’ the detective sergeant told me.
The inspector shook his head. He had said it before and he said it again:
‘She’s only a little slip of a thing.’
‘Tiny little girl,’ agreed the detective sergeant. ‘I suppose if your life’s in
danger you somehow find the strength.’
I documented in detail the scarring of the wrists, the scratch marks on the
back of the left arm and the defibrillation marks, measuring them and
defining their location.
‘We’ll have the tattoos and the wrists, please,’ I told the photographer.
He took close-ups of the graphically illustrated tattoos: the cartoon
character Top Cat and, on the right upper arm: LOVE. Below it, in larger
letters, was HATE.
Since a relative had already identified Anthony, we didn’t need the
tattoos for that purpose but routinely photographed them anyway. In those
days before DNA evidence was used, many a body was identified by
tattoos, particularly if early decomposition defied other means.
Although the ligature mark was so significant, I now checked for other
indications to confirm Anthony had been asphyxiated. The first tell-tale
sign was the redness of the skin on his face, caused by the obstruction of the
thin and easily compressed veins in the neck. The arteries serving the brain
are much wider and more resilient to pressure and so the blood can still
enter the head through them – but, because the veins are obstructed during
asphyxiation, it cannot return to the heart. However, the main indicator –
whether asphyxiation is the result of choking, suffocation, strangling, or
some other cause – is found in and around the eyes. Many, or even most,
people develop multiple tiny pinpoints of blood on the conjunctivae, the
inner lining of the eyelids, when asphyxiated. These are called petechial
haemorrhages: similar pinpoint haemorrhages can also develop, rarely,
when someone coughs or sneezes violently. They are less common in
suffocation but almost everyone dying of strangulation will show them. As
did Anthony. I held his eyes wide open with forceps so that the
photographer could see them. Snap–flash!
I measured Anthony’s height (5’11”) and then turned him over so that his
back could be photographed. There was a gasp from PC Northern. I felt
ashamed for a moment that I’d forgotten him and my intention to steer him
through this, but then, I hadn’t made a single cut yet. When I looked up, I
saw he was staring at Anthony in horror.
‘Oh my God, she beat him black and blue!’
I shook my head.
‘No, no, that colouration is just one of the normal processes of death.’
He stared at me uncertainly.
‘It’s called hypostasis. Some people call it lividity. I know it looks like
bruising and it can be really alarming the first time you see it. But it’s
absolutely normal.’
I explained in some detail the science of hypostasis, how it is gravity’s
pull over the red blood cells after death which creates such shocking purple
areas. I also pointed out how forensically valuable it can be. Since the laws
of gravity dictate that the staining always shows at the lowest point, it
reveals the position the body has lain in after death. But, if the body has
been moved to a different position, then an overlapping pattern, like a
shadow, will tell the story. Hypostasis can be misleading though. Somebody
dying face down, nose pressed into a blanket, will have a livid face with
blanching around the nose and mouth: normal hypostasis. It is too easy to
assume from this that suffocation has taken place, and I have known many a
pathologist fall into this trap.
Now that Anthony lay on his front, I could minutely examine his neck
below the hairline. There was no sign of any ligature mark here. Nothing. I
called the photographer over to record this and then turned Anthony over
again. Here was the mark, right across his throat, and only his throat.
Since I hadn’t made a cut yet, PC Northern might have been hoping that
by some miracle I wouldn’t need to. He had been sufficiently interested in
hypostasis to relax, or almost. Then I picked up my trusty PM40, large and
heavy. Through my earliest years of performing post-mortems on sudden
natural deaths, there had only been its little cousin, the scalpel. As I moved
into forensics, the PM40, a knife specifically designed for post-mortems,
with bigger, removable blades, had begun to dominate and by now it had
long been every pathologist’s best friend.
Its handle slipped easily into my palm, its weight felt reassuringly
familiar. Suddenly all chat ceased and the tension in the room was almost
palpable. I heard PC Northern take a deep breath as if he expected it to be
his last for some time. But for me, picking up the PM40 felt good, as
though I were a conductor picking up his baton. The orchestra is about to
play.
I made my usual first cut, straight down the middle of the chest.
I said, ‘We can all see that Anthony was strangled, and we have a
statement to that effect, but I have to check that there wasn’t some other
cause of death. A natural cause, perhaps. A heart problem, for example, or
maybe he had a condition that might have made him especially vulnerable.
I’ll have to examine all his organs to establish that. But first, of course, I’ll
have to examine the injuries inside the neck, beneath the ligature mark.’
No response from PC Northern.
I carried on working, talking all the time.
‘The internal damage caused by strangling may not be very dramatic.
Anthony was just twenty-two. At his age, the cartilage in the larynx and
around the thyroid is still pliable. In older people, it becomes increasingly
calcified and more brittle so it’s more likely to be broken during
strangulation.’
PC Northern inclined his head in something like a nod. Or was he trying
not to retch?
‘Strangling has interested pathologists for generations because nobody
fully understands the mechanism that causes death,’ I continued. ‘It was
once assumed that victims were asphyxiated. Even today most lay people
probably think that constricting the neck simply cuts off the air supply. But
we know that asphyxiation alone can’t always be the cause because some
victims die very quickly from pressure on the neck. In fact, a few die almost
instantly, giving no signs of classic asphyxia. And even those who do show
those signs have generally died too quickly for lack of oxygen to be the sole
cause.’
To my delight, PC Northern’s interest in this exceeded, for a few
moments, his revulsion at it.
‘So how do they die?’ he asked weakly.
‘Well, we know that compression of the jugular vein – here in the neck –
will increase venous pressure in the head to an unbearable extent – that’s
what turns some victims blue. Pressure on the carotid arteries, here, means
the victim will rapidly lose consciousness as blood supply to the brain is cut
off. But strangling can also put pressure on the nerves of the neck, which
then can affect the parasympathetic nervous system. This controls the
bodily processes we don’t really think about, like digestion. One of the
main nerves in this system is the vagal nerve and you can die instantly from
neck pressure, which, via a complicated mechanism, instructs the vagal
nerve to simply stop the heart beating. It’s a reflex reaction.’
‘Is that how Anthony died, then?’ asked the police officer, peering at the
inside of Anthony’s neck.
‘His head and neck are congested and there are petechial haemorrhages
in his eyes. That suggests asphyxia, or certainly not an instant death.’ I
leaned over the body. ‘A very famous pathologist called Professor Keith
Simpson records the example of a soldier at a dance who, lightly and
affectionately, tweaked his partner’s neck – and then saw her fall down
dead. He’d tweaked her parasympathetic nervous system. Ever since then,
defendants in strangling cases have tried to argue that they had no intention
to kill, they simply took hold of the victim’s throat, and the victim’s vagal
reflex caused them to expire for almost no apparent reason.’
‘But Theresa Lazenby used a tie,’ one of the detectives pointed out, a
little reluctantly I thought. How had she won over these hardnosed men so
effectively?
‘Looking at the injury, I’d say she used the tie and held it there for quite a
while,’ I confirmed. ‘So if that’s her defence, she’s on rocky ground.’
‘Her defence is that he was trying to kill her,’ said the detective.
‘Poor kid,’ agreed his colleague.
PC Northern, although not participating in this conversation, was still in
the room and I’d like to think it was thanks to my reassuring patter that he’d
managed to stay so long. He plunged outside only when the mortuary
assistant arrived to cut the skull so that I could remove the brain. During
this noisy procedure, in which a special saw is used, even the two
experienced detectives looked away. Although the SOCO, for whom this
was an everyday event, chatted with me over the roar of the saw, it was
impossible not to acknowledge, at some deep, instinctive level, the smell of
heated bone.
When I had finished the post-mortem, the police officers went back to the
station to brief their colleagues and to sign off duty.
‘And I’ll tell you what we need after that. A pint. Or three. Fancy joining
us at the Duck and Ball, Doc?’
I would have enjoyed seeing PC Northern come back to life with a pint
but, of course, for Jen’s sake, I had to decline. So I headed south. But all the
way I had a sense that something wasn’t right. I felt uncomfortable. It was
like putting your shoes on the wrong feet or your shirt inside out. The
Anthony Pearson case was nagging me. Something to do with the girlfriend
who had confessed to killing him. Something the police officers had said
about her. But whatever it was floated away like thistledown whenever I
came close to grasping it. No doubt all would become clearer tomorrow
when I wrote up the post-mortem report. And there was no time to think
about it now, I could see my own front door. Portal of delusion.
I deluded myself that it was possible to detach my emotions totally from
the evidence I daily encountered of man’s inhumanity to man. To feel
nothing beyond scientific curiosity when confronted by death’s
manifestation of the madness, the folly, the sadness, the hopelessness, the
utter vulnerability of mankind. To be blokeish, the way my colleagues
seemed to be. Invincible at work, untouched by the mortuary’s vanity fair
laying bare all it means to be human, untroubled by any complexity in the
concepts of right and wrong. And then, in another one of those Clark Kent
moments, to walk through my own front door and turn back into the warm,
loving, emotionally supportive, wholly engaged husband and father I
thought I was underneath my work persona. So. Deep breath. Stop thinking
about what Theresa Lazenby had done to Anthony Pearson and how. Just
stop. Key. Door handle. Step. Smile. Be jovial. Ask questions. Cook. Smile.
Read stories. Smile. Over supper, talk to Jen about her day, about the work
she must do tonight. Don’t think about Anthony Pearson, that thin trickle of
blood from the side of his mouth, the red, ragged line of the ligature. That’s
OK then.
The next day at the hospital I took the post-mortem notes out of my
briefcase. A smell – broken branches, winter woodland – briefly wafted out
with them. The smell of the mortuary.
I handwrote my report for Pam to type. It concluded that Anthony
Pearson had no natural illness and gave as cause of death ‘Ligature
strangulation’. I noted that
the position and distribution of the bruising of the neck suggests that the assailant was
behind the deceased while pressure was applied, and that the ligature was not crossed
behind the neck.
I still could not decide what was bothering me about the case but once
the report was submitted I quickly forgot about it. I assumed that the Crown
Prosecution Service would be contacting me eventually to give evidence at
the trial of Theresa Lazenby, and then I would get the file out and start
thinking about it again. For the time being, I was too busy.
15
I was now proud to be master of my moods, slipping from homicide to
home without dropping a stitch. I was also proud to be the smooth
comforter and conveyor of information to those present at but repulsed by
post-mortems. In fact, I had come to regard myself as a five-star, fully
competent controller of emotions. Until I met relatives of the deceased.
Relatives, with their burden of shock, horror, grief. Relatives, looking at
me for answers to the often unanswerable (‘Did he suffer, Doctor?’).
Relatives, wanting to know the truth but greatly fearing the truth. Relatives’
emotions filled rooms like a huge and unstable spongy mass, absorbing all
the available oxygen, while the relatives themselves sat awkwardly on hard
chairs, passing tissues around, mouths open, eyes wet, heads shaking.
Waiting for me to speak. Relatives, with their capacity to erupt into anger or
hysteria or tears, frankly scared me.
This was something I had to learn to deal with, and the first lesson came,
strangely, when a case taught me there was something much worse than
relatives. And that was no relatives.
It was winter and I was called to the house of an old lady whose body lay
naked and huddled under the table. The police were treating this as a crime
scene and it certainly looked as though someone had been searching for
valuables: cupboards and drawers were open, their contents spilling
everywhere. Some of the lighter furniture had been shoved on its side.
‘Cold in here!’ I said to the police officer. The weather had warmed up
over the last day or so but the large old house was still chilly.
‘Damp,’ he agreed. ‘That makes it colder.’
‘Didn’t she have the heating on?’ I asked.
He shook his head. ‘No central heating.’
A detective overheard this.
‘Probably intended to light a fire but the intruder must have got in before
she had a chance.’
We looked around at the high-ceilinged room. The hearth had been swept
and there had been no attempt to start a fire. There was an ancient two-bar
electric heater in one corner. It was not plugged in.
I stared again at the fallen shelves, their contents – books, medication,
knick-knacks, cards – all over the floor, the small chair on its side,
newspapers that had clearly once been piled now smeared unevenly across
the rug. I looked at the hunched, defensive body of the woman. She was
pitiably thin. The scene was pitiable.
‘What do we know about her health?’ I asked.
‘Nothing yet, Doc.’
‘Has anyone spoken to the neighbours?’
‘Yeah, they don’t know much about her, kept herself to herself. Next door
said they thought she was going a bit doolally.’
The police officer nodded. ‘The cleaner said she was definitely losing the
plot.’
Doolally. Losing the plot. Forgetful. Doesn’t know what day it is. So
many euphemisms.
In the kitchen, stale bread. An unopened tin of sardines. A tin opener. A
jar of marmalade. A bread knife. Curious marks around the lid of the
marmalade indicating perhaps that someone had tried to slice it with the
bread knife, open it with the tin opener. Letters, most of them circulars or
official looking, in the fridge.
No more euphemisms. I said, ‘Dementia.’
‘Expect she thought the intruder was a long-lost son or something,’ said
the detective. ‘She probably answered the door and threw her arms around
him. There’s no sign of a break-in, no sign of a scuffle in the hallway.’
‘Who found her?’ I asked.
‘Cleaner.’
‘Yeah, she couldn’t get in this morning and called us. Said the old girl
was one sandwich short of a picnic and didn’t realize she was in here:
thought she might have wandered.’
‘How often does the cleaner come?’
‘Once a week but she’s just been on holiday for two.’
A scenes of crime officer put his head round the kitchen door.
‘OK by us now if you want to move the body, Doc.’
‘Got anything much?’ the detective asked him.
‘Nah, lots of her fingerprints, can’t find any prints from the intruder.
Must have worn gloves.’
I turned to the detective.
‘In my opinion, there was no intruder.’
He blinked at me.
I said, ‘Only the cold.’
By now there were four officers in the room. They said nothing.
‘I believe she died of hypothermia. I think she may have lost the mental
capacity, or maybe even the physical ability, to switch on the heater, let
alone light the fire.’
The detective started to shake his head vigorously.
‘Now, come on,’ he said. ‘It’s not that chilly!’
It is a myth that, in order to die of hypothermia, you have to be outside
the house on a mountainside in freezing temperatures. We know that the old
and vulnerable (and actually the young and vulnerable) can die indoors in
air temperatures that are as high as 10°C – and that even higher
temperatures can be lethal if there is a chilling wind outside or a strong
draught inside.
If the body’s core temperature falls below approximately 32°C then heart
rate and blood pressure fall and there is a dulling of consciousness. If the
body’s temperature falls below about 26°C then death must almost certainly
follow, although there is a famous case of someone who reportedly
recovered – albeit mutilated by frostbite – from a body temperature of
18°C. (In forensic medicine it is amazing how often you find just one
exceptional exception. Followed always by a defence barrister trying to
make it sound commonplace.)
Hypothermia is, surprisingly, a not at all unusual cause of death. Its
victims may have fallen in the sea or other cold water, or they are drunks
who have dropped off to sleep in the park or they are young children who
have been neglected. The great majority of victims, however, are elderly.
Perhaps they think they cannot afford heating – and perhaps they really
cannot – or perhaps physical or mental disability prevents them from
switching it on. Sometimes hypothermia is simply the final step in a tragic
pattern of depression and apathy towards eating, heating and personal care.
In this case, the homicide team simply refused to believe that no one had
broken into the house.
‘Look at the state of the place, Doc! God knows what he took, he’s gone
through everything!’
‘And why’s she got no clothes on? I’m just hoping you don’t find the
bastard’s interfered with her …’
I said, ‘I believe she undressed herself.’
‘Because she was cold!’
‘Come on, Doc!’
‘And you think she threw all her own stuff around, I suppose?’
But this looked to me like a classic case of hide-and-die syndrome. The
old lady had almost certainly given in to that strange counter-intuitive urge
that can arise in those who are dying of cold. They take off their clothes.
Survivors have described feeling very hot as their temperature dropped and
really thinking that stripping off was a completely sensible thing to do. This
is a common response to hypothermia. Less common, but another
recognized syndrome, is the way some victims hide. In corners. Under
tables. And, in doing so, they frequently pull over furniture or empty the
contents of low-level drawers and bookshelves on themselves.
The team was sceptical about hide-and-die syndrome. The detective
insisted that I would find evidence of homicide at post-mortem and, in fact,
I knew it might be hard to prove my theory. Hypothermia can be difficult to
diagnose in a body after death because dying of cold and the cold of the
dead can have very similar appearances. Sometimes there are tell-tale
external signs, like pinky-brown skin discoloration around the knees and
elbow joints in white-skinned people. And the crucial diagnostic finding is
the presence of numerous small dark ulcers in the stomach lining.
In this case, to my relief, I found both these clear indicators. Death had
certainly been caused by hypothermia. I was pleased to have my theory
confirmed but strangely upset by the truth. The old lady, living and dying
alone, felt like a caricature of my grandmother and my aunts and their
friends, all women whom I remembered living alone in the north of
England. When I had holidayed there as a child, the world of older single
women had seemed part of a firm structure of friendship, family,
community and support. If they could no longer cope alone, they lived in
care and remained part of a community. But the deceased woman had lived
alone without any such structure. She had effectively died of neglect.
Perhaps self-neglect, but still there had been an absence of care – from
friends or family or community – which had allowed this to happen. From
the pictures on the bureau she seemed to be someone’s mother or aunt or
grandmother. Where was that someone? Where were these relatives who
did not seem to bother themselves about her? Would they care now that she
was dead?
I found it hard to cope with the emotions of relatives of the deceased but
now, for the first time, I actually wanted to meet a few relatives. I wanted to
explain to this woman’s children exactly how their mother had died. They
made no attempt to contact me. Nor did they show up at the inquest. After
gathering further information about the deceased, the coroner gave a verdict
of accidental death, accepting my cause of death: Hypothermia with
precipitating dementia. There was only me, a junior police officer and the
coroner in court to hear this verdict. What a sad and lonely ending to a life
that was.
When the next opportunity to meet some bereaved relatives arose, I dreaded
it but reminded myself that coping with their emotion was better than
contemplating the cruel isolation of the uncared-for. Which didn’t entirely
eliminate my dread. At the thought of these relatives I felt something like
nausea and even considered saying I was too ill to attend. But I knew there
was no escape. I would have to engage with the pain of their loss. Which, I
now admitted to myself, meant recognizing the resonance of my own, long
suppressed pain.
This case was a difficult one. The family’s misery was acute because
their elder daughter had walked into her fifteen-year-old sister’s bedroom
one morning to find that the girl had died in the night – for no immediately
apparent reason. Alannah had been a keen ballet dancer, sweet-faced and
lovely. Her parents and siblings were baffled, shocked, devastated by her
death, and their GP, or perhaps the coroner’s officer, had therefore arranged
for them to see me to discuss it.
I met them in the relatives’ room at the mortuary. This had been
decorated sympathetically in soft colours. Lighting was subdued and the
room was soundproofed from the clangs of trolleys and any inappropriate
whistling by the staff. I ran in, the keen young pathologist who had just
given a lecture and was shortly scheduled to rush off and carry out another
post-mortem, then get home to his children. As I opened the door I was
wondering how quickly I could get this over with.
Before me sat one entire family in shock. Mother of the deceased. The
deceased’s father. Her brother. Her sister. The sheer physical presence of
their great grief brought my own life to an abrupt halt. Stop all the clocks.
I desperately wanted to be kind to them. I opened my mouth to speak.
And then closed it again. Their suffering was unbearable. I felt it begin to
soak into me, like some indelible dye. Misery engulfed me. What kindness
could I offer, what could I possibly say? A sob escaped the brother. The
sister’s head was in her hands. Tears ran down the father’s cheeks.
Suddenly I wanted to cry with them. And I never cry, never, ever, certainly
not since, or perhaps even when, my mother died. I have no recollection of
crying as a teenager or as an adult. I have not cried, not once, at the cruelty
and sadness that parade endlessly through my professional life. Just ask my
wife. I don’t cry. But now I wanted to. As if I had to witness someone else’s
tears in order to unleash my own.
Except, of course, that professionalism required I did nothing of the sort.
So, they waited patiently until I was able to mumble my way through my
condolences. Then there was an excruciating silence.
At last someone spoke. It should have been me but it was the deceased
girl’s mother, a woman whose face revealed her devastation but who
retained her composure.
‘Are you all right, Doctor?’ she asked. Her voice, suffused by grief, was
kind and generous. Generous because she was looking at me with
something like compassion.
I assured her, rather shakily, that I was fine.
‘Can you … can you shed any light on Alannah’s death for us?’ she
prompted.
Of course! That was my role here. She had reminded me. They didn’t
need me to share their grief. They didn’t require my tears for the beautiful
daughter taken from them.
Snap. I moved into professional mode. I had a knowledge of their
daughter that they lacked; knowledge of how her body worked, of what had
happened that terrible night. She had, in effect, spoken to me. Bodies do.
An examination tells me so much about the deceased’s lifestyle, perhaps
even their personality, but most of all about their death. In the case of a
homicide, what the deceased says to me, as long as I listen carefully
enough, can help bring a perpetrator to justice. In the case of Alannah’s
death, I could comfort her family with what I had learned from her.
This was certainly not my first meeting with relatives but it was here that
I finally understood the obvious. Families who ask to see the pathologist
want just one thing. The truth.
Alannah suffered from epilepsy and had been prescribed the appropriate
medication. I explained that, as expected, toxicology had established there
were no other drugs or alcohol in her blood. Crucially, it had also been
established that she had taken the correct amount of medication for her
condition. No overdoses, no forgetting. Nor had she been asphyxiated by
bedding during a fit.
My external examination ascertained there were no marks on her body
indicating a struggle with another person or interference of any kind. My
internal examination confirmed there was no congenital heart problem or
other obvious cause of death. And there was no evidence that Alannah had
died during or after a seizure in the night.
‘Then why? Why?’ sobbed her father.
I asked them for Alannah’s medical history. Of course, I had read it, but I
wanted to make sure there was nothing that had slipped through the notes.
When they finished speaking, I knew that, in the complete absence of other
explanations, the cause of death must be her epilepsy.
Nowadays we know about SUDEP – sudden unexpected death in
epilepsy. We know it is something that can happen without warning to those
who suffer from epilepsy, usually in the night and not necessarily after a
seizure. We still don’t exactly know how or why SUDEP occurs – and back
then the evidence for SUDEP was even more anecdotal.
So, I could give them this evidence but I couldn’t give a detailed
explanation of the exact mechanism of Alannah’s death. Perhaps faulty
electrical wiring in the brain, an electrical discharge or neurone storm that
stops the heart? SUDEP is a mystery. They accepted what I said but there
were other things they needed to hear.
They needed me to say, ‘It wasn’t your fault. She took the right
medication for her epilepsy in the right doses.’ This was the truth. I said it.
They needed me to say, ‘She isn’t dead because you failed to hear her cry
for you in the night.’ This was the truth. I said it. And I added, ‘It is most
unlikely that Alannah cried out at all. But IF she did, and IF you had heard,
and IF you had rushed in, there was still nothing you could have done.’ That
phrase is important to so many of the bereaved. One of the normal phases of
grieving is guilt. There was nothing you could have done won’t magically
wipe away guilt, but it may allow it to pass more quickly. I hope so.
So that is what I gave them. The truth as I understood it. Unvarnished by
phrases designed to save them from it. Beautiful in its simplicity. Unfiltered
by the rawness and violence of the emotion a death causes. Allowing
myself to become involved in their feelings had added a complication to the
truth that could help no one, and I determined never to let it happen again.
I watched as Alannah’s sister unwound herself from the strange,
defensive contortion she had adopted. The brother stopped sobbing. The
father dried his tears. Not for long, perhaps. But somehow the truth seemed
to help them.
That interview changed the way I received relatives and, to some extent,
took away my horror at dealing with them. I stopped trying to save the
bereaved from their misery and now tried to deliver only the truth as kindly
as possible – while accepting that the truth is not always simple and
singular. It can be a fractured, fragmented beast. I may not see all of it. And
truth can be different things when viewed from different viewpoints –
which means some families say they want the truth then simply refuse to
believe it when it doesn’t fit with their preconceptions or expectations.
Not this family, though. But they did have other questions, and I have
been asked those same questions by many families many times since.
The brother, in a low voice, almost whispered, ‘What is it like to die?’
Answer: I don’t know.
I can comment that, even if it occurs in the most violent of
circumstances, death is finally an experience of supreme release and
relaxation. Therefore, with no scientific evidence and based purely on my
own instincts and my experience of seeing people die in A&E departments
and on the wards, I’ve come to the conclusion that, while few people
actually want to die, when it happens, death itself is probably actually
pleasurable.
When I said this, the surviving daughter of the family, who had been the
one to find her sister’s body in the morning, blurted out, ‘She looked so
peaceful! As if she was having a nice dream!’
I have very often heard that phrase: ‘She looked so peaceful!’ In fact, the
facial expression of the deceased does not, in my view, necessarily mean
that death was peaceful. The calm composure of the dead is simply the
result of, I believe, the total relaxation of the facial muscles after death.
Given the comfort that look of peace can bring the living, this is one truth I
distribute economically, although, if asked, I will stick to my policy of
honesty. But the dead girl’s sister was making a comment, not asking a
question. The lines of Pope my father gave me at school came back to me:
’Tis not enough, your counsel still be true,
Blunt truths more mischief than wise falsehoods do.
Death may bring a pleasurable release, but whatever immediately
precedes it can, of course, be terrible. Now the girl’s father, in a hoarse
voice, asked a classic question: ‘Did Alannah suffer, Doctor? I hope she
didn’t suffer for long!’
Pathologists are asked this question so many times. And in answering it,
the facts can become very grey as the need to comfort the bereaved
stumbles against the hard rock of truth.
Many choose to tell the relatives of those who die in violent
circumstances that the patient would have passed out or become
unconscious quickly and then died peacefully. Even when they are not sure
this is the case. In fact, it is very hard to assess suffering or how long the
body can bear it before dying. I can review injuries and diseases and make
some guess at the level of pain they would have caused. And I can suggest
how long death may take in some circumstances. But, from the body itself,
there are seldom absolutely clear indicators of death’s speed.
There is a myth that finding a lot of fluid in the lungs – pulmonary
oedema – is an indicator of a slow death. This oedema is a common part of
the dying process for most people: as the heart beats less and less
efficiently, normal physiology means that fluid leaves the blood vessels and
fills the lungs. So, people who have their heads chopped off will show no
oedema in the lungs at all because their death has been so fast. But the
opposite isn’t true: a lot of fluid in the lungs does not necessarily point to an
agonizingly slow death.
How, then, to answer this family’s – any family’s – questions about
suffering and speed of death? I decided to follow the hunch I had developed
into a technique in the post-mortem room: offering knowledge to alleviate
painful emotion.
I said, ‘Most people misunderstand death. They see it as an instant event.
You think that one moment your daughter was alive. And the next … gone.
But death just isn’t like that. Humans only switch off completely, in one
moment, like lights, if they’re vaporized in a nuclear explosion. In all other
circumstances, death is a process.’
Death is a process. I’ve used that phrase so many times now. During this
process, each organ of the body shuts down at a different rate according to
its own internal cellular metabolism. And then this in turn triggers further
processes which eventually lead to the decomposition and natural disposal
of the body. Dust to dust.
The simple process of death that many of us recognize from a bedside
may last only seconds – or it can last tens of seconds or even minutes.
Technically, it lasts hours as the body dies cell by cell. Some cells, skin and
bone, can remain ‘alive’ for as much as a day: these cells continue to
metabolize without oxygen until their reserves are finally exhausted. In fact,
these cells can be removed and then grown in a laboratory for some days
after a body has been certified dead.
For a few hours there might be random heartbeats. Digestion may
continue. White blood cells can move independently for up to twelve hours.
Muscles may twitch. But that’s not life. There may be exhalation. But that’s
not breathing.
Various definitions try to pin down death, but each definition is a
struggle; morally and scientifically. When the individual will never again
communicate or deliberately interact with the environment, when he is
irreversibly unconscious and unaware of the world and his own existence:
that’s death. Of course, that may define someone in a deep sleep or under a
general anaesthetic – conditions that are reversible. It may also define
someone in a coma or persistent vegetative state. But these patients do have
heartbeats and show at least some brainstem activity: that’s not death.
When there is no heartbeat, no breath, and the ECG shows a flat line,
that’s real death. Occasionally people have told me that they knew the exact
moment, sitting at a bedside, when a relative died. But they are almost
certainly wrong. They are referring to the time that breathing and heartbeat
stopped. They witnessed a somatic death. Cellular death takes longer.
The bereaved family listened to my explanations without sobbing. There
was silence as they tried to knit the knowledge I had shared with them into
the particularity of their own, tragic, experience.
‘I can’t tell you how long it took Alannah to die, but the anecdotal
evidence is that sudden unexplained death from epilepsy is swift. I can’t tell
you how much she suffered but there is no evidence from her body that she
suffered at all.’
‘She may not even have woken up? She may not have known she was
dying?’ asked the father hopefully.
The temptation was to agree wholeheartedly. But that would not be
entirely truthful.
‘We can never know exactly what Alannah experienced. I can only say
that there is no evidence of distress. And repeat that death is a process
during which life is gradually wrapped up and put aside. And that I believe
this to be a pleasurable process.’
The family looked ready to leave the room calm, engaged, relaxed.
However, then the father said, to my astonishment, ‘It’s really helpful to
hear all this. But … I just can’t stand the idea that you’ve cut my daughter
up into pieces.’
At that, the mother, who until now had been so strong and composed,
burst into tears.
‘We would have liked to have seen her one last time. But we can’t!
Because you’ve cut her up!’
The son choked. The surviving daughter’s face crumpled. The father
started to cry again.
It had never really occurred to me before then that for most people I am
the dark figure of death cloaked in Halloween colours who has ‘cut up’
their loved one. And it was the first time I encountered the false assumption
that we pathologists turn beautiful corpses into mangled meat. Although
I’ve met it often since.
Many people – and, I am sorry to say, this includes police officers and
sometimes even coroners’ officers (who really should know better) –
wrongly advise relatives who wish to see a body after post-mortem that
they should not do so. Because of ‘what the pathologist has done’. People
who cannot bear the idea of a post-mortem, even those who are
theoretically professionals but who may never have visited a mortuary or
seen a body after post-mortem, simply should not impose their own feelings
on relatives at such a sensitive time. No doubt they hope to offer support.
Instead they can inflict deep and long-lasting scars on those who want and
need to say a last goodbye.
The result of this mythology is that, sadly, many relatives who are asked
to agree to a post-mortem of their relative will not do so. Of course, they do
not always have a choice: if death has been sudden, whether it is natural or
accidental, the coronial system will usually take over, and the coroner will
certainly demand a post-mortem if homicide is suspected. Society needs to
know, and this greater good overrides the relatives’ wishes. Bearing in mind
that a relative could be – and quite often is – the murderer.
The general horror of post-mortems only became completely clear to me
when I read a statement a relative gave following a major disaster. She had
learned that a post-mortem had been performed on her son without her
knowledge. Since he was a disaster victim she thought the cause of death
was already obvious:
In my view, it was wrong to carry out any unnecessary invasive procedure which
disfigured the body and showed lack of respect for it and for my family’s emotional and
religious needs. To me, he was still my son, and any unnecessary mutilation of his body
was an unforgiveable intrusion.
I really do understand that it is hard, very hard, to recognize the finality
of death. To understand that the son who was thinking and feeling and
animated yesterday is not so today. To comprehend that yesterday he would
have been in agony when I inserted my knife but today he cannot feel it at
all. And perhaps the hardest thing is to see the insertion of that knife not as
an intrusion but an act of respect and, yes, maybe of love.
Here are the words of the QC who was acting for the group of angry,
bereaved relatives that included the mother I quoted above:
The care with which our dead are treated is a mark of how civilized a society we are.
Much goes on for understandable reasons behind closed doors. For this reason, there is a
special responsibility placed on those entrusted with this work and the authorities who
supervise it to ensure that bodies of the dead are treated with the utmost care and respect.
That is what bereaved and loved ones are entitled to expect and what society at large
demands.
Who cannot agree with him? Except that he was representing relatives
who, among other miseries, were angry that their loved ones had undergone
a post-mortem.
For me, his words pinpoint why post-mortems are so important. When I
perform one, I am thoroughly, efficiently and perceptively delivering to the
dead not just ‘the utmost care and respect’ which a civilized society
expects, but love for my fellow man. I am ascertaining the exact cause of
death and in doing so it is very distressing to be regarded as a mysterious,
cloaked butcher. I sincerely hope that those to whom I have spoken directly,
or who have heard my evidence in court about the death of their relative,
appreciate that I did my job with care. And, I believe, love for humanity.
Very gently, I tried to help Alannah’s sobbing family to understand that
her body had not been brutally mutilated at post-mortem but respectfully
investigated – for their sake, her sake and society’s sake. The world did not
shrug its shoulders and say, ‘Oh well, there goes another fifteen-year-old
girl.’ It demanded to know the truth.
I assured them that her body had been faithfully and beautifully restored
after this process – as all bodies are – by my colleagues. Mortuary
technicians are rightly proud of their skills. Alannah’s family should have
no fears about seeing her. Indeed, they must do so. Seeing a loved one’s
body is a way of saying goodbye, recognizing death’s finality and
celebrating a life.
I made arrangements then and there for them to see Alannah. They
thanked me quietly as I left. I knew how long and hard the grief road would
be as it unfolded in front of them. Maybe I had made a few steps on it easier
for them. For our different reasons, none of us there has probably ever
forgotten that meeting.
Of course, I can’t personally feel grief for every one of the tens of
thousands of people on whom I’ve carried out post-mortems. Grief is not an
emotion I experience as I incise a body. It is something I experience when I
see others suffering their own loss, either within the controlled forum of the
coroner’s court or, more informally, at the mortuary or office. I’ve come to
terms with the need to manage my response now. In the years since that
meeting about Alannah I’ve even come to believe these contacts between
pathologists and the deceased’s loved ones should be arranged far more
often. Information, its very solidity and certainty, can provide not just
clarity but support, relief and a sound basis from which relatives might,
eventually, move on.
For myself, I would say I have spent a working lifetime respecting and
understanding relatives’ pain – while trying not to internalize it. Analytical
readers will by now be associating my reluctance at the start of my career to
meet relatives with the death of my own mother so early in life. And at my
subsequent willingness to engage with others’ grief they will say, ‘Aha! He
couldn’t allow himself to experience the enormity of grief for his own loss!
So, he experiences it again and again in manageable proportions through
the grief of others. And, at the end of the meeting, he walks away from it!’
I accept that there is probably something in that theory.
16
Although I carry out my work with respect and a sense of loving humanity,
I do so with an essential scientific detachment. A few years into my job, I
did think I had become rather good at leaving detachment at the door of our
house, so I was a bit disappointed at Jen’s hints that I was applying it to
family life; that the jovial, loving husband I’d thought myself to be was
instead a dour and preoccupied workaholic.
Moi? Surely not. So I was caught stabbing the Sunday roast with a series
of different knives from different angles while I waited for the oven to
warm up. So what? I was convinced I could deduce the exact size and shape
of a knife from the injuries inflicted by it and there was no lump of meat so
like a human lump of meat as a joint of beef. I’d be a fool not to carry out a
little experimentation when I was waiting to shove the beef into the oven.
Wouldn’t I?
‘You mean, Daddy, that you pretended our lunch was a human person?’
asked Anna, putting down her knife and fork. ‘A human person being
killed?’
‘Don’t be silly, it obviously isn’t a human person,’ I said, tucking into my
beef briskly.
‘My meat’s full of stab marks,’ added Chris. ‘Look!’
I had expected greater loyalty from the other male in the family. I
glowered at him over the joint. But it was too late. By now everyone had
put down their cutlery.
Our lives were absurdly busy. I tried to get back from work most
evenings in time to take over childcare from the nanny and cook the dinner.
Jen was now working junior doctor hours. Forget synchronizing diaries, it
was a matter of cobbling each week together.
Then, when we were out one day, our house burned down. Not entirely,
but enough to mean we had to move out. The fire was either started by an
electrical fault, by an aggrieved offender against whom I’d given evidence
(as the police suspected), or it was my fault. We never did find out which,
but Jen tended to favour the last of these possibilities.
We stayed with friends, we rented accommodation, we fussed over
builders, we agonized over whether to sell the house as a burnt-out shell
and buy another, or restore it and return. I tried not to regard the house, with
its intact structure and black, smoky, largely missing interior, as symbolic of
my marriage, but even I could see that the difficulties and pressures of
living in a series of temporary homes were not making that marriage any
smoother.
What a relief when the holidays arrived. Kids and dogs were all piled
into the car and we progressed slowly north up the motorway. Off to the Isle
of Man, where my generous in-laws were ready with food, love, parties,
towels for the beach, teatime for the children, whisky-and-sodas for the
evening. Austin and Maggie were becoming charming caricatures of
themselves, he the solid colonial, she with groaning wardrobes of
glamorous dresses, the pair of them with more friends than you could fit in
the house, perhaps fit on the island.
Jen and I called a truce during those holidays and tension between us
evaporated as Jen’s good parents worked hard to ease all our burdens. I was
only caught once in the kitchen sticking Maggie’s knives into the beef and
Maggie was intrigued rather than angry. Then, happy and refreshed, with
brown, giggling children in the back seat, buckets of seashells wedged
between flip-flops and dogs thumping tails full of sand, we returned to
London looking very different from the tight-jawed individuals who had
left.
It took about two days for us to revert. And even before we became those
busy parents and doctors again, the tensions returned. We didn’t have rows:
we had seething and we had silences. I was probably trying to make up for
a seething or a silence, the cause of which I forget, when I bought Jen a new
dress and flourished tickets for the opera. Tosca. I was really keen to see it,
I knew it would be my sort of evening because a colleague had described
Tosca as ‘a wonderfully forensic opera’.
Such an evening out was very extravagant by our standards and we
certainly looked forward to it. The only possible fly in the ointment being
that I was on call and hadn’t been able to swap this shift with someone else.
Sure enough, the babysitter had already arrived and we were in the bedroom
getting ready when the phone rang. Jen watched me answer.
‘Pam here.’ Tough, no-nonsense, organizer of disorganized pathologists
Pam. That could mean only one thing. Jen saw my face and her eyes
narrowed.
‘Right,’ Pam said, her habitual way of starting a conversation. ‘You’ve
had a call-out. Shocking case. Whole family shot dead in their beds,
probably last night but not found until this afternoon. The father survived.
Just. Badly wounded, now in hospital.’
That sounded like the kind of case I should go to right away. And my
face must have said so. Jen saw it and turned her back on me. The lovely
new dress was still on its hanger. Instead of lifting it off, she sadly opened
the cupboard and put it away.
‘Where?’ I asked Pam.
‘I’ll tell you where, but you’re not going tonight.’
I inhaled sharply. I always went immediately.
‘You got Jen that dress and you bought those tickets and there’s no way
you’re cancelling that.’
Pam always knew everything.
‘But –’
‘Go running off to some homicide now and she’ll never speak to you
again! It can wait.’
This was enough to give any forensic pathologist palpitations. The point
about rushing to a crime scene is that, quite apart from police urgency and
the relatives’ need to know, we’re at our best when the body’s early
processes such as cooling and rigor can offer us the most accurate indicators
of time of death.
I said, ‘Pam, I think I’ll have to go because –’
‘I’ve already said you’re not going tonight. And if you’re worried about
time of death, stop. The police already know. The father left a suicide note
and the neighbours heard some bangs and said it was about 1 a.m. Anyway,
it happened last night and the police have been working on it this afternoon.
With three bodies to process and all the other stuff, they won’t need you
until tomorrow.’
‘But –’
‘The dead aren’t going anywhere and the husband’s in hospital so there’s
no rush.’
There was always a rush!
‘Just get there at eight tomorrow morning, it’s all arranged.’
‘But –’
‘Dick. You’re not arguing with me, are you?’
Nope. No one argued with Pam.
So we went to the opera and Jen wore the dress and it was a lovely
evening except that somehow the family shot in their beds went to the opera
with us. I was trying not to think about them but I did. Which body would I
start with? How bad were the father’s wounds? Had he killed them all and
intended to kill himself. But bottled it at the last minute? Or just misjudged
the shot? Or had there been a mad, masked intruder who had made him kill
the family and write a suicide note – in which case, why had the father been
spared?
I didn’t go to the call but it had been obvious to Jen that I was more than
willing to, and that Pam had stopped me. Jen was monosyllabic while we
were out. We returned home and waited until the babysitter had left. And
then we had the row. Well, Jen rowed. In the face of her anger I was very,
very quiet, like a small mammal crouching in the hedge until the bird of
prey flies over. I had somehow managed to ruin our wonderful evening out.
‘I can’t stand it,’ Jen said, ‘when you go quiet and moody on me. I’m
upset! Why don’t you reach out to me? Comfort me?’
Erm. Because …
‘Is that why you work with corpses, Dick …?’
Now just a minute.
‘Because they won’t notice when you act completely detached around
them?’
Touché!
Although Jen blamed the early death of my mother for my ability to
withdraw as soon as the going got tough, I suspected it was more likely
because of my father’s volcanic tempers. I had depended on him totally and
mostly he created a secure, loving world. Which was rocked from time to
time by his outbursts. The long-term result is that I barely ever allow myself
to loosen the lid of my own volcano.
Of course, I do feel angry or sad or disappointed sometimes. But, instead
of displaying it, I retreat into silence. I seldom argue and never shout. Well,
I did once, perhaps around this time or a little earlier. Many years later my
daughter said at her wedding that she could remember me losing my temper
on only one occasion in her entire life (new suit, children, bath, waterpistol). I felt no shame. In fact, I’m quite pleased I managed to lose my
temper at all.
Our romantic opera evening wasn’t the success I’d hoped for, so I
thought I might as well scuttle over to the homicide scene right away. But
one look at Jen’s face told me this could be grounds for divorce, so I
contained myself. However, I was up at 6.30 the next morning, Saturday,
getting ready to leave for the murdered family’s house. Jen did not wake up.
Or seemed not to, anyway.
I arrived at 8 a.m. as instructed by Pam. This was going to be a long, long
day. There were still plenty of police around but surprisingly few reporters.
Probably they had been and gone. There isn’t a homicide – especially a
multiple homicide – that is so ghastly it goes unreported. In my experience
the worse the better, as far as journalists are concerned. Even today Jack the
Ripper’s ugly murders continue to make headlines. Only the details of some
sexual murders seem to evade the press – although that is probably more to
do with information being withheld than a sense of decency towards the
bereaved.
When I entered the house of the murdered family, it retained that silence
of death I now knew so well, although police officers were still busy and
people were chatting. What I found inside was a ghastly parody of the
family homes up and down the land that were waking up to a normal
Saturday morning.
It was in very good order. There was none of the chaos which can
characterize murder scenes: no empty bottles of beer and vodka, no filthy
carpets, no decaying kitchens, no blood-filled bathrooms. This was a family
which cooked and ate well and took care of themselves and each other.
The teenage daughter’s bedroom was clean and pretty, with homework
completed and put away by her school bag. Her clothes were neatly folded.
She lay in the bed in her shiny pyjamas. A single bullet had passed straight
through her head.
In the next room, her older brother lay on his back, shot through the
centre of his forehead, from about six inches. Apparently as he slept. There
were no signs of a struggle or any other disturbance.
Their mother, a pretty, dark-haired woman, lay on the right-hand side of
the marital bed. Hands together as if in prayer beneath her right cheek.
Peaceful. The bullet had smashed through her left forehead and a trickle of
dried blood ran down her face.
‘No doubt about it, the father did it,’ said the SOCO.
‘How bad are his injuries?’ I asked.
The officer had been there much of the night and looked grey-faced and
dishevelled.
‘Well, apparently he’s not going to die.’
I wondered if the father had wanted to die or if merely injuring himself
really had been his intention. He’d been very certain about the previous
three shots. Had he also shot himself in the head? If so, it would have been
hard to be sure of avoiding death. Strange.
I discussed with the photographer what pictures he had taken and then
told him what more I needed. I took one final look at the mother and both
the children before agreeing with the coroner’s officer that these three tragic
bodies could be removed to the mortuary.
Once they had gone, and because there were no more fingerprints to be
taken, I could wander around the scene and look at it in more detail. At that
time, no one had heard of DNA evidence, and forensic science certainly
was not as advanced as it is today. The result was behaviour at the scene of
a crime that would nowadays be regarded as worse than casual. So, while
we were always quite careful not to touch anything other than the body, if a
fingerprint taken turned out to belong to a pathologist, then the only result
was that we had to buy the SOCO a bottle of whisky.
The post-mortems of the family were straightforward: here, after all,
were three healthy people, all of whom had been shot once through the
head. Yet it was a most haunting case. That house, with its silent, ordered
rooms and incongruous bodies, certainly stayed with me. Its darkness
followed me home and I could not quite eliminate it as I closed the door
behind me. It was late afternoon and the children were running riotously
through the house. The sight of them, laughing and pink-faced, so alive,
made me absurdly happy.
I went straight to the desk where Jen was bending over her books and put
my arms around her and apologized for being so wrapped up in my work
and for being cold and detached at home. Knowing nothing could be worse
than the cold detachment of the family whose bodies I had just examined, I
whispered in her ear a promise that I would try harder to be a more loving,
open, emotional husband.
It later emerged that the father who had shot his own family had not shot
himself in the head. His injuries were not life-threatening. As soon as he
was discharged from hospital, he was sent straight to a psychiatric unit. A
police officer I met later, on another case, told me that it had been easy for
the father’s defence team to convince everyone that he was deranged
enough to be charged with manslaughter with diminished responsibility.
Manslaughter usually results in a lighter sentence than murder, so of
course it is preferred by defence teams. And diminished responsibility was
often in those days achievable. Later, the 2010 law reforms tightened the
definition of diminished responsibility, so that it now can be applied only to
those with a recognized medical condition. But for many years before these
reforms, the plea of diminished responsibility was fair game for defence
counsel and I fear was often abused. In this particular case, however, it did
not occur to me, or apparently anyone, that the father could be anything but
mad. You’d have to be completely crazy to shoot your family. Wouldn’t
you?
I assumed the case would end there, but in forensic medicine, despite the
fact that patients are certainly dead, cases have a habit of coming back to
life. Some months later, I was called to give evidence at the father’s trial. I
was amazed to find that he had been charged, not with manslaughter after
all, but with the murder of his family. The police officer told me quietly that
the father had begun a relationship with a female resident in the psychiatric
hospital. He had confided to his new lover that he was just pretending to be
mad and that in fact family life had been getting on his nerves. He had
simply shot his family because he was tired of them.
You might think this is clear evidence of psychiatric disorder but, when
the lover passed her information on to the authorities, they immediately
initiated in-depth interviews and the result was that he was judged to be of
sound mind. The charges were changed to murder. The father was found
guilty and given a life sentence. The terrible scene of family destruction in
the heart of that house of apparent harmony had been not the result of
madness but cold-blooded, intentional and planned homicide.
His trial reminded me of my resolution to be a more caring husband. I
don’t think anyone, least of all my children, ever accused me of being an
uncaring father. I got them ready in the mornings and as soon as I was home
from work I was busy with reading, cooking, homework, games, bedtime.
But I was definitely slipping in the husband department.
Jen wanted a demonstrative, loving husband. I thought I was
demonstrating my love by taking on the lion’s share of responsibility for
home and childcare during her long training. However, when I thought
about the father who had just been jailed, I realized that he might have
appeared to take care of his family adequately – while actually silently
planning their murders. I realized that it was, in fact, perfectly possible to
participate fully in family life while one’s mind was somewhere else
completely. Did I do the same thing? Was I thinking about work too much
while playing the good father? Could this be the reason Jen was
complaining? Was she in fact asking for more loving, focused engagement?
I pondered. But I did nothing. We were back to a busyness which seemed
to preclude any loving engagement. One of us was always just about to
leave for work. And if we were both home there were a thousand topics
which required our attention: the children and their schoolwork, difficulties
at work, the house repairs …
I wondered how I was supposed to fit love into all this? Should I write it
in my diary: ‘Staff meeting 5 p.m. Love 7 p.m.’? And what was I supposed
to do? Bring home flowers? Light candles at meal times? I would have
liked to ask other men how they managed to make warmth, humour and this
love business a part of their everyday married lives, but such a conversation
would not have been acceptable in work circles. In fact, it would have been
impossible. We talked about homicide, not love. And so I blundered on.
17
The Crown Prosecution Service eventually contacted me about the Anthony
Pearson case. His girlfriend, Theresa Lazenby, had been charged with
murder and her trial was shortly to take place.
There was a pretrial meeting (a luxury Simpson enjoyed throughout his
career but which I have seen disappear in the course of mine) and before it I
refreshed my memory with the notes and photographs of the case.
Prosecuting counsel had also sent me some more material, including
transcripts of Theresa’s police interviews.
As I read, I remembered how the detectives who interviewed her had
found it hard to connect the strangled body of an adult male with that young
woman. How protectively they had spoken about her. I soon began to
understand why.
In the interview, Theresa explained that she had known Anthony for five
years. She had a four-year-old daughter by him who lived with her parents.
She divided her time between the flat she shared with him, where she
usually spent her nights, and her parents’ house nearby, where she spent her
days.
At the time of Anthony’s death, Theresa’s parents and daughter were
away on holiday. She described the day in detail and I can only say that it
was a very ordinary day that ended in a very extraordinary way. The
juxtaposition of the two was almost surreal. She bought a birthday card for
a friend and video-recorded a TV show for her absent family, went to her
grandmother’s to ask after her grandfather, who was poorly. She tried
unsuccessfully to borrow a little to help pay for a holiday she planned with
friends in Tenerife. So far, so normal.
Later, she met Anthony at the pub. He was drinking heavily and strangely
annoyed with her for arriving early. He did not approve of the holiday (‘You
slag!’) and then demanded money to buy more drinks and then for cannabis.
Theresa borrowed money for Anthony from her occasional boss behind
the bar. A complicated evening of drinking, cannabis and anger followed.
Theresa herself consumed only one half of lager and no cannabis and her
description of events showed her as the appeasing girlfriend of a very
erratic and difficult lad. By the time they arrived home with a takeaway
pizza, her statement suggested he was out of control:
I gave him his pizza in the front room and he said he’d lost the cannabis and I said: don’t
be silly. So I started searching through his pockets and he pushed me away against the
wall … he threw two glass ashtrays at the wall … And I said: you always have to break
things. He said: yeah, that’s right.
He just freaked out and he started pulling the videos off the mantelpiece and throwing
things around, he was shouting and he started pulling the record player apart and I went
to hold him to stop him doing it any more (crying) and he punched me in the head and I
fell over and I cut my hand (shows palm of right hand cut) and there was glass all over
the place and I was lying by the sitting room door and he couldn’t open it because my
head was there so he kept banging my head with the door.
He went into the toilet and he was calling me and so I went in and he cut his arm with a
razor blade on purpose … I got a towel and I said: don’t be silly. I got a towel and put it
around his arm, I think it was his right arm, I think he flicked the towel off first. Then he
pulled the string out of the light socket …
I went in our bedroom and he was throwing more things, my little ornaments. He went
into the kitchen. I’ve got a glass dining table and I said please don’t smash it but he
picked up some salt and pepper pots and went into the bedroom and threw them out of the
window. And he picked up the mirror so I closed the window and I grabbed him and we
both fell back on the bed (sobbing) and I was holding him.
He cut my arm. I don’t know what it was but I moved my arm (shows right forearm
cuts). I moved my arm and he elbowed me in the stomach. I put my arm over again, he
cut and bit my arm (shows cuts and bruising right upper arm). I picked up a piece of tie
at the side of the bed (sobbing), it was on the bedside cabinet on the left side and I just
strangled him with it. I didn’t want to hurt him, I just wanted to stop him hurting me, I
just didn’t know, I just didn’t want him hurting me any more. I was shouting at him to
leave me alone, to get off me. Get off me! Get off me! Then when he stopped hitting me I
ran out of the house and came here.
Q: When you were strangling Tony, were you on top of him on the bed, or him on top of
you or side by side, which was it?
A: We was near enough side by side. I was on the left side of the bed. I was on my back.
He was on my leg below me. I wasn’t trapped. He hit me in the stomach a few times, I
got the tie around his neck … (sobbing)
Q: Carry on …
A: I crossed the tie over, I pulled it tight to stop him hitting me. I don’t know how long
for but when he stopped punching me I ran out of the house and ran here.
Q: Did you mean to kill him?
A: (sobbing) No, I didn’t want to kill him.
Q: Did you think you’d killed him?
A: I knew I’d hurt him because he kept trying to catch his breath. He went purple. His
mouth, his tongue, his tongue was sticking out … I looked at him. I knew I hurt him. I
just had to get out of the house. I had to get here to get help for Tony. I told the man
straight away, the policeman.
Theresa went on to say that Tony had assaulted her in the past but, amid
much sobbing, that she loved him and felt he needed her. It seemed she was
a very young mother – she and Tony must have had the baby when they
were still in their teens – trapped in an abusive domestic relationship by her
belief that he needed her.
I was moved by her protests, her insistence that this was the first time she
had retaliated and then only under immense physical threat from Tony.
Sometimes perpetrators seem more like victims, and Theresa was both
suffering and remorseful. But the prosecution was planning to rely on my
evidence. Which had to be unbiased. So I was determined to adhere to the
truth, with its beautiful simplicity, and not allow emotion, with all its
treachery, to muddy that simplicity.
The case conference was held in one of the Crown Prosecution Service
rooms above the Old Bailey. The courtrooms are majestic and woodpanelled: there is no court in the UK that gives participants more of a sense
of justice, its history and importance, than Court 1 of the Old Bailey.
There is nothing majestic, however, about the offices above.
I waited in a room with battered furniture and ill-fitting windows and
suddenly counsel, a senior and a junior, burst in. They had come straight
from their case in the court below, still wearing their gowns, throwing their
wigs on the table, greeting me by name before the more formal proceedings
began. The two detectives arrived shortly afterwards. Spending time at a
post-mortem together can be a bonding experience and we shook hands
warmly like friends.
We sat around a large, scratched table drinking tea from china mugs –
barristers didn’t do polystyrene – with the various files and photographs
spread out before us. All of the Metropolitan Police photographs were put
into small folders with stiff brown covers bound by black plastic rings.
I was silent as everyone else discussed Theresa Lazenby’s plea. The
charge was murder, but they thought it was highly likely that her counsel
would offer a plea of guilty to manslaughter with diminished responsibility
– which, of course, carried a much shorter sentence. The detectives were
keen that this would be accepted. It was obvious that they liked Theresa and
that they believed she had acted in self-defence. Indeed, unusually when the
defendant has been charged with murder, they had not even objected when
she was released on bail.
‘Have you read her police interview, Dr Shepherd?’ senior counsel asked
me.
‘Yes.’
‘And you’ve seen the pictures of what he did to her before she grabbed
the tie?’ asked a detective.
‘No, I didn’t receive those pictures.’
There was a lot of shuffling and then the barrister produced a folder. The
police photo folders I usually saw contained pictures of murder scenes and
of post-mortems. This folder was different. From the pages stared a pretty
young woman, who was very much alive.
‘So,’ I said. ‘This is Theresa.’
Her youth and health lit up the pictures. She was fresh-faced and her
long, red hair was sensibly tied back. Just as the detectives had told me all
those months ago, she was rather sweet-looking. A world apart from the
usual murder suspect.
I carefully examined each photo while everyone else sipped their tea and
chatted. Finally, I looked up.
I said, ‘I think …’
Then I paused. Was I sure? I did not want to be blinded by any
preconceptions of the case into forgetting the horrific consequences of a
mistake.
The police officers watched me intently, waiting. The lawyers frowned.
The pause went on too long.
‘Yes?’ prompted senior counsel in a tone that indicated my hesitation
could be jeopardizing the credibility of what I was about to say.
Then I remembered that nagging doubt I had felt on the day of the postmortem. It was caused, even then, by a dissonance between fact and story.
And now I had found another major divergence between the truth and
Theresa’s version of it.
Yes. I was sure.
I said, ‘I think all Theresa’s injuries are self-inflicted.’
Counsel for the prosecution gaped at me.
‘What?’
‘She did all these things to herself.’
His junior colleague reached for the photos.
‘Those cuts on her arm. You’re saying she made them?’
‘I believe so. I do not believe that she killed Anthony Pearson in selfdefence because he was attacking her with glass, razors, what have you.’
They exchanged glances.
‘You’ll say that in court?’
‘Yes. I’d like more time to study this case, of course.’
‘How …?’ The detective inspector was unshockable. But he looked
miserable. ‘How can you be so sure that Tony Pearson didn’t cut her?’
In fact, the injuries in the pictures bore all the classic hallmarks of selfinfliction. If you’re being attacked, you get out of the way, twist, move, do
something: you can’t help it. Unless you’re being pinned down – which
Theresa says she wasn’t – or you’re immobilized by drugs or alcohol –
which she clearly wasn’t – then you simply don’t let someone slice your
skin over and over again in the same direction and in the same place.
And there was further evidence. The wounds were only in the most
common sites for self-inflicted injuries (the sites are common because
they’re easily accessible) and the force used was only moderate. It’s not
hard to be forceful when you’re in a fury and cutting someone else. It’s very
difficult if you’re injuring yourself.
I explained all this.
‘These certainly weren’t defence injuries,’ I said.
The two barristers looked at each other again and then at the police
officers. I noticed once more that, although the detectives had charged her
with murder, it was clear they liked Theresa. One of them picked up the
folder containing her pictures.
‘Look at her face. Tony Pearson must have scratched her there,’ he said.
I shook my head.
‘No. These are fingernail injuries.’
I held a hand up to my own face and mimed scratching it in exactly the
same way, in exactly the same place.
‘If I remember rightly, the victim’s fingernails were bitten down. They
were far too short to make these scratches.’
I reached for the post-mortem folder. The notes I had made at the postmortem were attached and as I moved them the air became lightly scented
with that smell, its pungency like snapped elder branches, of the mortuary.
I flicked through the folder rapidly until I found a picture in which
Anthony’s fingers were clearly visible.
‘Yes, he obviously bit his nails. They wouldn’t have been sharp enough
to inflict the scratches to her face.’
I handed it over. The detectives studied it and passed it to senior counsel,
who put on his glasses to peer closely before dropping it in front of junior
counsel, who glanced at it with difficulty and then shut the book rapidly.
I picked up the pictures of Theresa.
‘On the other hand …’ I held one up in which her fingers were visible.
‘Her nails are cut to a sensible length but she could certainly scratch her
own face with them.’
They passed it around. Then there was a silence.
‘And the bite mark on her arm?’ demanded the first lawyer.
‘She could reach her upper arm with her own mouth.’
I demonstrated, not very ably, by biting at my own arm. Then I opened
the photo folder again.
‘And look carefully, the size of the bite marks indicate a small mouth, too
small for a man. We can confirm that by measuring her mouth, of course,
but we’d need to get a forensic odontologist to examine her. Bite marks are
highly individual.’
There was another silence.
‘I did notice in your statement,’ I said, turning to the inspector, ‘that
when Theresa appeared outside the police station you initially called an
ambulance. And then –’
‘When we examined the injuries, we cancelled it,’ he agreed.
‘Because you didn’t think they were too serious,’ I reminded him.
Counsel asked, ‘Did you come here today expecting to tell us this?’
‘I hadn’t seen the pictures. But I certainly intended to tell you that
Theresa’s version of events could not be true. I knew that when I read the
transcript of her interview.’
The prosecution lawyers were looking excited while the police officers
were assuming the weary expression of those who suspect they have been
duped.
I was confident, at least partly because I had discussed this evidence with
my colleagues back at Guy’s and we were all in agreement. I knew from the
ligature marks that she could not have put the tie right around his neck,
crossed it and pulled it tight as she described. The tie did not go right
around his neck. It did not cross. It went only across the front of his neck.
I said, ‘At first I thought she must have strangled him from behind by
pulling on both ends of the tie but she’s given this very accurate description
of his face as he was being strangled.’
‘She did say she was at the front of him.’
‘That, at least, I believe. But if she did it in the way she describes then a
conscious adult male could have easily stopped her.’
They waited. A detective, his face puzzled, murmured, ‘So how …?’
‘Tony Pearson was very drunk, not far off three times the legal drinkdrive limit for alcohol. Also, he’d smoked cannabis, which would have
magnified the effect of the alcohol. The most likely scenario is that he was
lying on the bed, incapacitated. I think she must have simply held the tie
across the front of his neck and pressed down. And he must have been too
drunk to struggle. There’s a good case for saying that he was face down,
that she ran the tie under his neck and simply pulled back on the two ends.
But then she wouldn’t have been able to describe his face so accurately as
he died.’
The lawyer leaned forward.
‘Are you telling us there was no fight in the flat? That she made it all up
to justify the fact that she just …?’
‘I think there was an argument in the flat – the neighbours heard
something, after all – but it was on nothing like the scale she describes.
There is no evidence that she was a victim of physical violence and that her
action was self-defence. On the contrary, I believe that she must have
strangled him when he was unconscious or barely conscious. Then selfinflicted her injuries.’
Everyone looked at everyone else.
‘No way do we take manslaughter for this one,’ said senior counsel.
‘This is murder. And we’re not going to let her get away with self-defence
either.’
We shook hands and went in our different directions. The trial was
scheduled for a few weeks’ time and we would next meet in court.
In my earliest court appearances, I had been so nervous that I had only been
able to stare back at whichever barrister was asking me questions. Or
sometimes, if feeling bold, I’d looked at the judge.
Iain West once came to watch me in the witness box. Afterwards, in the
pub, he said, ‘So, who needs to believe you and understand your evidence?’
In typical Iain fashion, he answered his own question before I could.
‘Not counsel, that’s for sure. Counsel knows what you’re going to say,
and he knows what he’s going to try to make you say. As for the judge,
you’re not really in the business of convincing him either.’
‘The jury.’
Iain nodded his huge head.
‘The jury, Dick,’ he rasped in his Scottish accent. ‘The jury, don’t forget
the jury.’
Of course, he was right. In court, Iain was in his element. Twelve good
citizens and the public and press gallery too was his idea of an audience and
he never failed to play to them. I am simply not an actor and could not do
courtroom drama any more than I could do emotional, loving husband.
However, I did try to learn from Iain. I studied him in the Old Bailey,
how he listened to counsel’s question, thought for a moment, turned to face
the jury, paused to take a deep breath and place his hands on the edge of the
witness box, from which position he could make extravagant gestures, and
then replied to the question as though the jury had asked it. His eyes ran
constantly over their faces. He delivered his words with aplomb. For the
jury, it must have been like having the entire Royal Shakespeare Company
in their living room.
There was no way I could emulate Iain’s performance, but by the time
the Lazenby case came up I was turning to the jury as much as I could.
Since I am in court to offer scientific evidence and not to pass judgment, I
tried then and try now not to look at the defendant. But in those early years
I sometimes failed to control my curiosity. I couldn’t resist the urge to see
the person accused of the heinous crime whose effects I had witnessed. I
was often amazed at how nondescript most murderers seemed. So many
looked like that mild-mannered individual you barely notice sitting next to
you on the train until he obligingly picks up your ticket if you drop it.
As I stepped up into the witness box in Regina v. Lazenby, I found
myself sneaking a glance at the defendant.
I saw a young woman who, as in the pictures taken immediately after the
murder, was pretty, fresh-faced and alert. Her red hair hung in a neat and
charming pony-tail. When I gave evidence, her eyes glistened with tears.
Her lawyer passed her a tissue. She dabbed at her cheeks and bowed her
head. I saw members of the jury stare at her with compassion.
How could this small, delicate woman be one of the UK’s very few
female stranglers? How could she have carried out this act in cold blood
and then had the presence of mind to inflict false injuries all over her body
before presenting herself tearfully at the police station? It seemed
impossible. I almost doubted my own conclusions.
Nevertheless, I held firm under cross-examination. And I learned later
that the pathologist instructed by the defence to review my findings and
opinions did not contest my report: he agreed that at least some, or even
most, of Theresa’s injuries were self-inflicted.
The prosecution was insistent, based on my evidence, that Theresa had
simply strangled her boyfriend when he was either unconscious or too
incapacitated to struggle against her. All the indications were that Theresa
had not needed to defend herself against the extremely drunk Anthony. But
it was hard for anyone to believe a woman so sweet and remorseful could
have done such a thing unless to save her own life. It was certainly hard for
the jury to believe. They accepted her plea of self-defence and found her
not guilty.
Theresa’s lawyers had successfully persuaded them that the prosecution
had failed to prove their case beyond reasonable doubt. Beyond reasonable
doubt is a high hurdle to jump, but the one that I would want applied if I
ever found myself on the wrong side of the dock. Despite this, I was
surprised when Theresa walked free from court. I knew that, through me,
Anthony Pearson had spoken, but it was also patently clear that the jury had
not listened. I felt they had ignored the evidence and their verdict was
simply a vote of sympathy for an allegedly abused woman.
Jen raised her eyebrows that evening as I talked about the case
extensively and from the heart. I explained how a woman I believed to be a
murderer had just walked free. I suspected her youth and beauty were
factors in her acquittal, and that seemed unfair.
‘Well it makes a change from a pretty young woman being the victim,’
Jen pointed out. She was baffled by her unemotional husband’s rather
emotional response to this court case. Even I was starting to feel
uncomfortable at trespassing into an anger zone I usually avoided.
‘I’d better pull myself together,’ I said. ‘I can’t get upset like this about
every court case that goes the wrong way.’
And, of course, I did pull myself together. The Lazenby case was
probably the last time I allowed myself any emotional involvement in the
outcome of a trial. It is my job to ascertain the scientific truth. I tell the jury
that truth. They have the right to do with it what they will – after all, they
hear all the statements and details of a case, which I seldom do. I now
desire no further involvement once I have offered the facts.
So, no more emotional payloads for me. No more sneaking a look at the
defendant or grilling police officers on the outcome of a trial. Very often I
am not informed of the verdict when I’ve given evidence in a case. If I
don’t spot reports in the newspaper then I have to ask police officers or
other colleagues who might have been involved. After the Lazenby trial I
decided never again to ask. I would be indifferent to the verdict and restrict
my interest to my own evidence. I must feel no crusading zeal to see
perpetrators behind bars and no emotional need for the jury to vindicate my
findings. Let Iain West put his heart and soul into his court performances
and then suffer personal devastation if the jury found against his evidence.
From now on in the witness box I would perfect the art of emotional
detachment I had learned in the mortuary.
I told Jen this and she looked sad.
‘More detachment,’ she said. ‘It’s your answer to everything.’
‘I shouldn’t let myself care about verdicts. I’m sure that’s right,’ I said.
Jen shrugged. ‘It was interesting watching you talk about that case with
so much passion. Maybe you should do it more often.’
I shuddered. Passion. I certainly didn’t want to feel that at all, let alone
more often. It was the sort of thing that could get you into a lot of trouble.
18
In the late 1980s the UK saw a series of disasters which claimed many
lives. Few if any of these disasters could exactly be called an accident. They
almost all exposed major systems failures. Or maybe this was a period
when post-war values of self-reliance were morphing into conflicting
interests of self and state. Certainly, attitudes were changing as the
population grew and the systems we relied on had to increase in size and
complexity.
In March 1987 the car and passenger ferry Herald of Free Enterprise
capsized outside the Belgian port of Zeebrugge because the bow door had
been left open: 193 passengers and crew died.
In August 1987 Michael Ryan went on a killing spree and shot thirty-one
people in Hungerford before killing himself.
In November 1987 a lighted match dropped down through an escalator
on the Piccadilly line at King’s Cross, causing a fire that claimed the lives
of thirty-one people and injured a hundred more.
In July 1988 the Piper Alpha oil rig in the North Sea blew up, killing 167
men.
On 12 December 1988 three trains collided due to signal failure just
outside Clapham Junction. Thirty-five passengers died and more than four
hundred were injured, sixty-nine of them very severely.
Later that month a bomb planted on a Pan Am jumbo jet exploded over
the Scottish town of Lockerbie, killing all 259 people on board and eleven
on the ground.
Less than three weeks later, on 8 January 1989, an engine fault developed
in a British Midland Boeing 737 which, compounded with pilot error,
brought down the plane on the embankment of the M1, just short of the
runway at East Midlands Airport. Of 126 people on board, forty-seven died
and seventy-four suffered serious injury.
In April 1989 ninety-six Liverpool football fans were crushed to death
and more than seven hundred were injured at Hillsborough stadium in
Sheffield. It was only in 2016 that a second inquest ruled the victims were
unlawfully killed due to gross negligence: the police, ambulance services
and safety standards at the stadium were all criticized.
In August 1989 a collision between a pleasure boat and a dredger in the
Thames claimed the lives of fifty-one people, most of them under the age of
thirty.
Each event shocked the nation. Each resulted eventually in significant
improvements, when emotions were calmer and the often multiple,
interconnected causes had been unravelled and analysed. Ancient systems
were overhauled, the health-and-safety culture blossomed – some might say
exploded – employers began to recognize the importance of training, of
corporate and state attitudes to risk and responsibility. These areas had
suddenly become more serious and security was no longer just a managerial
afterthought but a necessity.
I was involved, at emergency or inquiry stage, with many of these events.
Pathology learned a lot from them about how to deal with mass disasters –
and so did I. It was the lessons of this watershed era that enabled us to cope
efficiently with the terrorist horrors of the 2000s.
For me, the first such case was Hungerford. But this was largely an era of
transport disasters, and the first of these I worked on was the Clapham rail
crash. A fast passenger train from the south coast, full of commuters, drove
through a green light near Clapham Junction and rounded a bend on a
Monday morning at 8.10 a.m. – only to find that the slow service from
Basingstoke had halted on the same tracks.
An inevitable collision ensued. Because the green signal should have
been red, but wasn’t. Because a wire was loose. Because the electrician had
left it that way. Because he had taken only one day off in the preceding
thirteen weeks. And, although his managers thought his work was
satisfactory, later investigations showed that it had, in fact, been poor, very
poor or simply unsafe for sixteen years. It transpired that no one had
supervised or inspected anything he did because he was ‘trusted’ and
because there was no culture of inspection. The fundamental trigger,
however, was this: everyone had been rushing to replace the signalling
wiring. And why replace the wiring? Because it dated from 1936. And there
was a need to ensure greater rail safety. We are now inside a law of nature
that sometimes seems to account for the bulk of my work: the law of
unforeseen consequences.
At the collision, the fast train buckled to the right and hit a third train on
the adjacent rails going the other way. Fortunately, this train was empty,
heading back to Haslemere: the driver saw what was happening ahead of
him but had no time to stop. A fourth train, coming up behind the fast train,
was travelling at speed but, because the electrical current had automatically
shut off after the earlier crashes, it was slowing down and coasting around
the bend. The driver managed to apply emergency brakes in time to
narrowly avoid a further collision.
The thirty-five people who died were all in the front two coaches of the
fast train. These coaches were ripped open on one side. Closest to the point
of impact they completely disintegrated. The first senior fire officer on the
scene – and the collision had inconveniently occurred in a deep and wooded
cutting – looked down and immediately ordered eight more fire engines,
eight ambulances and a surgical unit, as well as cutting and lifting
equipment to extract trapped passengers.
A disaster plan is all about the victims, but at an initial glance so much of
it seems not to be relevant. Traffic and parking may appear to be minor
issues, but if these are not immediately controlled rescue vehicles cannot
get to or away from the site quickly. The site must be made accessible (in
this case, trees and railings were removed), hospitals must be put on alert
and the removal of the severely injured coordinated. Medical teams must
arrive. Casualty centres for the walking wounded must be set up and
managed, a casualty collection point must be provided as well as a
temporary mortuary. Every passenger must be accounted for and this
information must somehow be made available to anxious relatives (there
were no mobile phones in 1988). There must be stretcher bearers and
people delivering medical supplies to doctors, and the entire operation must
be co-ordinated by a forward controller who has established radio links so
that rescue workers can communicate.
This is a huge task, and it must be carried out at speed. Speed is only
possible after planning and practice. As it happened, 12 December 1988
was the first day the new A&E department at the nearest hospital, St
George’s in Tooting, was open. The staff who took the initial ‘red alert –
disaster call’ had to be persuaded that the rail disaster was real and not a
hoax from colleagues at another hospital.
The total numbers involved in the Clapham rescue were vast: they came
from all over London for the London Fire Brigade, the London Ambulance
Service, the Metropolitan Police, the British Transport Police, the British
Association for Immediate Care (specially trained doctors, mostly GPs, who
are on call to leave their day jobs and rush to disasters), British Rail, the
London Borough of Wandsworth (fortunately one of the very few local
authorities in the country at that time to have its own emergency plan,
which was put into immediate action, providing 134 invaluable staff) and,
of course, the Salvation Army, who arrived with a mobile canteen to offer
physical relief in the form of drinks and food but also psychological relief
to rescuers, staff and relatives.
The first role of the emergency services is certainly to take care of the
living, to extract the trapped and to get casualties to safety as quickly as
possible. Only after that come the dead.
The London Fire Brigade, as first on the scene, having been assured the
rail power was off, allowed the traumatized walking wounded to leave the
train. They were escorted to casualty centres in the adjacent Emanuel
School and the Roundhouse pub and there was a collection point for them
in Spencer Park.
Sixty-seven ambulances were used to ferry the wounded to hospital. The
thirty-three who died at the scene were removed along with any body parts.
Initially they were put in a temporary mortuary but their stay was brief, as it
should be. The coroner organized a fleet of undertakers to pick up the
bodies and body parts from here. They were to be taken to the mortuary for
full identification and autopsy. In any mass disaster, one of the key
questions, as well as dealing with the wounded, is: where do we put the
dead?
By 1.04 p.m. the last live casualty had been stretchered away from the
train. By 3.40 the last body was removed from the wreckage. Unfortunately,
no pathologist was sent to the scene so there were no detailed pictures taken
of the bodies in situ, which might have helped with identification. And it
would certainly have assisted greatly in our analysis of the injuries.
The mortuary chosen to receive the dead was that recently rebuilt and
state-of-the-art facility, Westminster.
Four of us from Guy’s went, including Iain, who was of course in charge,
as well as Pam, to keep us (and the Metropolitan Police) in order. Initially
we had no idea how many dead to expect, so we created a flow diagram
showing how the bodies would progress through the mortuary. This started
with the numbering, labelling and photographing of each body or body part
on arrival. Each then went straight into a specific fridge labelled with that
unique number.
The four of us, helped by mortuary staff, were working simultaneously,
and as soon as one of us was free, the next body, escorted by a police
officer, was taken from its fridge and again photographed. This is a crucial
part of the ‘chain of evidence’. We had to be able to prove that the body that
came into the mortuary as Body 23 was the body we examined as 23 and
that Body 23 was, eventually, when positively identified to the satisfaction
of the coroner, the one released to the undertakers for burial.
Initially we did not carry out full post-mortems but focused on
information that might identify the bodies. We described general
appearance, any jewellery, clothing or tattoos plus major obvious injuries
like missing limbs. The police filled in ID forms. The bodies were
fingerprinted and cleaned. They would be removed from their fridges a
second time for full post-mortem and for the retention of blood samples.
Identification was, and is, the first priority for the pathologists in any
mass disaster – there were many worried relatives, desperate for reliable
information. The number of a call centre had been given out through the
media for friends and relatives to phone, but it had no queuing system so
callers found it to be constantly engaged. One can only wonder at the anger
and frustration that caused. But the lesson was learned and call centres were
organized and designed differently after that. There were thirty-five deaths
but over the ensuing day the call centre took 8,000 calls, and there were
many more to hospitals and even mortuaries.
If injuries were slight the police gave information over the phone. Bad
news was delivered personally by officers. It would have been all too easy,
without proper care, to tell a woman her husband was dead when he wasn’t,
or vice versa. For instance, there were four people on the train with exactly
the same name. Incredibly, two of them were in one carriage – but only one
of them was dead.
Fingerprints and dental records were at that time the only really
dependable means of identification: it was no good relying on the loose
personal effects like handbags or wallets that arrived with the bodies as
these almost invariably turned out to belong to someone other than the
individual in that body bag. In addition, the police and fire service were so
keen to remove all human tissue that a body bag containing three body parts
very often contained the body parts of three different people and not one, as
the rescuers must have assumed. There were about sixty separate body parts
– heads, legs, jaws, internal organs – and they all had to be matched up. The
coroner’s staff and the police entered the details onto a database and from
this, gradually, complete human beings began to emerge in cyberspace …
the male, aged about forty-four, six feet tall, slightly overweight, balding,
birthmark on right shoulder, travelling in the train’s front carriage,
eventually turned into a person with a name. We were pleased to reach the
point of positive identification. But, of course, at that same point hope
ended for friends and family.
We continued working until the small hours of the next morning to get
the first view finished. Then we went home to rest in order to avoid fatigue
errors before returning early to begin the post-mortems. The bodies of a few
people who had died in hospital after the crash were now arriving. These
added to our workload but, since these individuals had all been identified by
relatives while in hospital, the process was much easier.
Most of the dead at the very front of the train had been killed by severe
injuries, not just from the initial impact but by forcible ejection from their
seats and hard contact with the unforgiving inside of the carriages. Some
died of traumatic asphyxia because the tables they were sitting at were
forced back into their abdomens, or because other objects fell onto them.
There were many lessons learned from Iain West’s overall report of our
findings, including the need to anchor seats to the floor and to redesign hard
surfaces to lessen their resilience in a collision. There were some calls for
seat belts, but this was impractical and has never been implemented on
trains. Overall, British Rail, which then controlled the signalling equipment,
learned that there were many improvements to be made both to routine
safety systems and to crisis systems. If any phoenix rose from the Clapham
ashes, it was these improvements.
And for me, there was a personal phoenix too.
The mortuary after the disaster was a busy, focused place and I got on
with my job. As I looked at each victim I remembered that they had set off
for work one morning and never arrived. Instead they had been crushed and
severed, their families bereaved. The ramifications of that would continue
for years, if not generations. I thought all this but I could not allow myself
to feel it. To feel anything. I knew that the intensity of my emotions was so
strong that I could not have worked and so the door on them had to be kept
slammed tightly shut.
At one point, I looked up to notice how very white the face was of the
police officer who had been at my side for some hours.
I said, ‘Do you need a break? You don’t look very well.’
He said, ‘Doc, I think I’m going to be all right. Because there’s one thing
keeping me going.’
I waited for him to tell me that a pint at the pub or the embrace of his
girlfriend would be his reward.
He said, ‘My flying lesson.’
I must have misheard. I thought he’d mentioned something about flying
…
‘Yes, Doc, soon as I finish my shift, I’ve got a flying lesson.’
I stared at him.
‘You fly a plane?’ I asked, incredulous. ‘That’s something I’ve always
wanted to try!’ I did not add, ‘… but have never been able to afford.’
Well, hasn’t everyone wanted to fly? But the idea of finding the money
then fitting flying into my everyday life, slotted somewhere between home,
giving lectures, departmental meetings, post-mortems and court
appearances … well, it seemed barely worth considering.
The officer said, ‘I’ll tell you, the fresh air up there beats the smell of the
mortuary any day.’
I looked around me at the collection of crushed limbs we were now
investigating. Did I need anyone to tell me that the clouds are a better place
to be?
The policeman said, ‘The Met has a flying club, that’s how I do it. If
you’re interested, I reckon you could join, seeing how closely you work
with us.’
A few weeks later I found myself at Biggin Hill. Precisely, at the
threshold of runway 2–1. More precisely, inside a two-seater Cessna 152
beside a police officer who was also a qualified flying instructor.
We’d sat with cups of coffee while he briefed me on this, my first lesson,
and then, heart beating wildly, fingers shaking with excitement, a buzz in
my stomach that felt like raw terror, I opened the throttle and runway 2–1
unspooled before me.
‘Pull back gently when we reach fifty knots,’ said my instructor.
‘Gently!’
I did so and the nose of the plane lifted. There was a heart-halting
moment as the rumble of the wheels on the tarmac faded then stopped and
suddenly all I could hear was the whoosh of the wind and the noise of the
engine. Yes! We were airborne.
We climbed. Up, up. The deep blue horizon shifted further down. I
looked at our speed. Seventy-five knots. We passed a cloud. Just flew past
it, the way the bus passed me in the mornings when I was about to miss it. I
was flying through thin air. In a tiny metal box. And I wasn’t falling down.
I realized I had been holding my breath. I exhaled. I inhaled. I dared to
look below me. The houses of Greater London were behind us and I could
see all the way to the south coast, all the way to Brighton. My eyes rested
on the sheer stunning beauty of the countryside laid before me like a feast,
like a woman in her finery, like a work of art, a picnic of clouds. I felt
elated. I was really flying. I was leaving behind the sad and the drab.
Mortuaries full of the still bodies of humans devoid of human spirit, the
small failures, the niggling worries, the disappointments, the silences at
home, the recent spate of that annoying compromise ‘Cause of death:
Unascertained’; the idiotic vanities and the frustrating rivalries. All the
joyless trivia which can paint life grey had simply disappeared to be
replaced by this surge of wild happiness.
I concentrated on the controls of a small plane suspended somewhere
over Kent and knew that if flying could make me feel this way, I must never
give it up. Ever.
19
I gave up flying after five hours of lessons. The fire in our house created
such an array of complications and pressures that wild surges of unbounded
joy were driven right off the agenda. Spending my very limited spare time
alone with an instructor in the air when I should have been spending it with
my family began to look downright selfish. So, it was back to PM40s by
day and chores by night: cooking, writing up post-mortem reports, phoning
builders. Back down to earth.
Not that life was boring. I loved the variety of my work – in one week I
might have a suicide by shotgun, a carbon-monoxide poisoning, a
drowning, a knife murder, a drug overdose, a variety of sudden natural
causes. Each had its own fascination, as long as one detached oneself from
the emotional payload death carried for the living who surrounded it. Drug
overdoses were still rare, particularly if the user had died with a needle in
the arm: that was certainly something to show interested colleagues (today,
of course, these cases are simply routine). There was a strong possibility
that the deceased, if an intravenous drug user, was HIV positive and so
drugs deaths triggered elaborate safety precautions. AIDS was still
sufficiently new and unexplained to be terrifying and, in those days of
ignorance about its transmission, fear stalked hospital corridors.
Iain West had become the UK’s, and perhaps the world’s, foremost expert
in death by bullet or bomb: his career had peaked alongside IRA activity
and his work regularly made headlines. I did appreciate the breadth of the
cases I dealt with but colleagues hinted that I, too, should find an area in
which to develop special expertise. What, though?
Drugs deaths were a growing trend, so was death by glue-sniffing, but
these generally demanded more of toxicologists than forensic pathologists.
Babies? No, thanks. I felt that few pathologists could enjoy working on
such morally complex and emotionally draining cases, although in fact this
specialization was to explode, in significance and complexity, over the
coming years.
My intellectual curiosity drew me towards knives, a method of homicide
as old as mankind and one I predicted would last on this planet as long as
man does. Or woman. One of the interesting aspects of homicide by knife is
that it is very often a woman’s weapon of choice. The knife in every kitchen
drawer in the land is a murder waiting to happen. And it is easy to use. No
training or specialist knowledge is required. Not even much force, really.
All that is needed is the ability to get close to the victim. But it was not the
domestic or street nature of knife murders that interested me so much as the
fact that, increasingly, from the incisions themselves, I often felt I could
attempt to reconstruct the events surrounding the homicide. And, although I
was coming to terms with the fact that, post-Simpson, the police didn’t
seem to regard reconstructions as proper evidence and lawyers less and less
often had the time or inclination to hear them, I could not entirely abandon
the reason I had become a forensic pathologist: to help solve death’s puzzle.
I don’t think I actively made a decision to be a knife specialist. It just
seemed to find me. And my interest was sealed after a call-out on a sunny
Sunday autumn morning when I had woken early to see the clear sky and
wish, sadly, I could fly a little aeroplane through it. Our burned house was
healed and sold, we had passed through the chaos of moving, the new house
was in something like order … but I knew that taking time out from work
and family to continue my flying lessons was still simply out of the
question.
The leaves were turning colour as I headed off through the crisp, cold
morning towards a village where an elderly man had been found in his
kitchen with his throat slashed. As I neared the address I met a line of
police cars parked at the roadside. A harassed young constable was trying to
persuade a knot of gossiping neighbours to move back.
The old man had lived in one of those big early council houses, detached
and built to last from solid black and red brick. The neighbours fell silent as
I approached. They listened as I identified myself to the constable, then as
he lifted the crime-scene tape and I walked through, they all started to talk
at once. In the corner of my eye, I glimpsed someone in a police car. A
woman, head in hands.
‘I’m the coroner’s officer; thanks for coming so quickly,’ said a big, redfaced man at the door who I guessed at once was, like many coroner’s
officers at that time, a former policeman. SOCOs were busy with their
evidence bags, and there were a couple of senior detectives. A police
photographer arrived.
‘That’s the daughter,’ muttered the coroner’s officer, gesturing to the
police car in which the woman sat. ‘Phoned and couldn’t get a reply, rushed
straight over …’
In the kitchen near the back door, feet stretching to the entrance of the
living room, lay the body of an elderly man.
‘Mr Joseph Garland. Eighty-two years old,’ the coroner’s officer
murmured in my ear.
Mr Garland lay on his right side. His clothes were bloodstained. Beneath
him the kitchen floor was bloodstained. The mat was bloodstained. The
cupboards and walls were bloodstained.
He wore pyjamas with a tweed jacket thrown over the top. His hands
were bloody. His feet were bare. By the open back door stood a pair of
bloody wellington boots.
I could hear the two detectives talking behind me.
‘So, they bang on the door or maybe he just sees them outside in his
garden. He throws on the jacket, gets into his boots, goes out there and …
they knife him but he manages to get back into the house, probably
reaching for the phone …’
I looked back at Mr Garland. The bloodstaining was unusually
distributed. His jacket and pyjamas were heavily stained on the front.
Confusingly, the blood extended down to the upper calf. There was no
blood below this except on the soles of his feet. The wellington boots,
however, were bloodstained on the outside and in a narrow rim on the
inside at the top.
It was obvious that he had been wearing the wellies at or after the time he
received the injuries. Then he had taken them off when he came into the
house. They stood neatly in what was almost certainly their accustomed
place by the door. Their owner probably had a long-practised, ingrained
habit of stepping out of them as he entered.
‘I bet he once had a wife who nagged him about bringing mud onto the
kitchen floor,’ I said to no one in particular.
I stared out into the back garden, which was being combed now by a
number of police officers. I saw a trail of blood leading to the greenhouse.
Outside it, Mr Garland’s pots were stacked. Inside, through dirty windows,
the summer’s tomato plants were visible. They were brown, dying off as
autumn closed in.
Beyond the greenhouse was a garage and parking area. A deep pool of
blood was visible in the parking area: clearly the wound had been inflicted
here. A red car stood nearby at an odd angle, the driver’s door not properly
shut, as if someone had leapt out in a hurry.
‘It’s the daughter’s,’ explained the coroner’s officer.
The photographer had finished his initial work now and I went back to
the body. I rolled Mr Garland over and a huge incised wound on the side of
his neck, just above the jacket, gaped at me. A knife had cut through the
muscles and the right jugular vein and partially severed the carotid artery.
There were a number of other horizontal wounds across the throat, but none
so deep as the wound that had most certainly killed him.
I felt his arms and legs. Rigor mortis had set in but was not fully
established in the legs. I took his temperature.
Another policeman was listening intently to his radio.
‘Suspicious van … two men, early twenties, approached a pensioner this
morning. Asked if he had any gardening work. The van was a white Ford,
registration probably included letters T and K …’
‘Get someone out there looking for it,’ said a senior voice, who then
introduced himself to me as a detective superintendent.
I had been crouching by the body and stood up now.
‘Could you ask his daughter if he was left-handed?’
The super looked at me for a moment and then disappeared to the police
car. Through the open door I heard Mr Garland’s tearful daughter confirm
that he was indeed left-handed. She knew what this question meant, even
perhaps before the detective, because she began to wail.
‘I don’t think this is a murder investigation,’ I said when the detective
came back.
The officers, busy around the scene, inside and out, all seemed to freeze.
‘This wound is self-inflicted. I’m afraid Mr Garland killed himself.’
The super shook his head.
‘That was our first thought. But we’ve searched high and low for a knife
and there just isn’t one.’
‘There must be.’
The detective began to look annoyed: ‘You can’t kill yourself and then
dispose of the weapon. There’s no weapon here. This is a homicide.’
‘Maybe he dropped the knife into the bushes.’
The super gestured to his team of officers, even now busy in the flower
beds.
‘This is their second sweep of the garden. It’s not that big and there’s no
knife.’
I was sure the knife was there. I was sure the old man had killed himself.
I paused and considered. How sure was I?
The detective was glaring at me. ‘You don’t know anything until you do
the post-mortem, Doc.’
People always think that by opening the bodies of the dead I will find
their secrets locked inside, like someone who cracks safes. But in this case,
I already knew a great deal from careful study of the body’s external
appearance.
There was no point in arguing, as I would have to do a post-mortem
anyway. I turned back to the coroner’s officer. ‘Can you arrange to take him
to a mortuary now?’
He nodded and called over two uniformed police officers.
‘Right, let’s get him bagged up and over to the Royal Surrey.’
I turned back to the super. I was confident.
‘Of course, I’ll do the post-mortem, but I’m sure this is a suicide.’
‘What makes you so sure?’ he asked me, and not pleasantly. It was a tone
I knew already but I’d rarely encountered it at the scene of a crime, where
there is generally quiet, good-natured teamwork. No, that sneer belonged in
court, employed by a senior defence barrister setting out to humiliate a
pathologist whose evidence inconveniences his client.
I responded in my most clinical voice.
‘First, the site of the injury. Mr Garland has cut himself several times,
and the site he’s chosen is absolutely typical of self-inflicted incisions.
They’re nearly always on the neck or the wrists. He cut the right side of the
neck, which would be most unlikely if he was right-handed. But you’ve just
confirmed that he was left-handed. And look at all those smaller injuries.
They’re parallel.’
The detective glanced, reluctantly, at the old man’s neck. I pointed to the
thin, superficial lines of blood on either side of the large slash wound and
explained hesitation injuries to him. ‘We don’t know exactly why people do
this: perhaps they’re just building up their courage. Preparing for the pain.
Or trying to find the right place. But hesitation injuries are strong indicators
of suicide.’
The detective still looked sceptical.
‘Those lines always mean it’s suicide?’
‘In my experience that is usually the case.’ My experience at the time
was not so very extensive, but I didn’t plan to tell the officer that.
‘If he cut himself out there …’ The detective indicated the pool of thick
blood in the parking area. ‘… and died just here, how much time would he
have had to dispose of the knife?’
I thought.
‘Up to a minute.’
Not that he would have been able to hide the knife after losing all that
blood. He might have been able to throw it but he had almost certainly just
dropped it.
The detective, who really seemed to want a homicide to brighten up his
Sunday, said, ‘Someone could have knifed him and run off with the
weapon.’
‘Well …’
‘It’s possible, you admit the possibility, that his wound was inflicted by
someone else?’
I hesitated. Of course it was possible, anything was possible. But it was
my job to collect and present evidence, not to speculate on every wild
theory.
I said, ‘It’s unlikely. But it’s possible.’
The detective looked triumphant.
‘However, I believe that the knife must be here,’ I said. ‘And in a fairly
obvious place.’
The team looking for the knife heard this. They paused. Some put their
hands on their hips, others stood straight, staring at me. They had been
searching for a while now and didn’t want to hear they had missed
something obvious.
I went out through the little back door, past the bloody wellington boots,
past the greenhouse and the old clay flowerpots, past an ancient tin bath that
lay on its side, following the blood trail to its source.
‘He lost a lot of blood and he was losing more fast as he moved back
towards the house, I really think he would have just dropped the knife
somewhere near this spot rather than throwing it,’ I said. ‘Perhaps the
daughter …?’
‘Says she hasn’t touched a thing.’
When there is a suicide, often a relative or friend suspects it has taken
place. Perhaps Mr Garland had threatened suicide or maybe he had just
seemed very depressed. I tried to imagine the middle-aged daughter arriving
at speed in her red car, heart beating, scared of what she might find. The
first thing she would have seen was the pool of blood. Her car had
screeched to a halt just short of it, and, leaving the vehicle askew across the
parking area, barely even shutting the door, she would have jumped out and
run into the house to find her father.
‘No knife, no suicide,’ stated the detective firmly.
‘Could you reverse her car, please?’
Everyone looked at everyone else and the detective went to ask the
daughter for the keys, then came out and slowly backed the car away from
the parking area.
Beneath the wheel’s original position lay a bloody, bone-handled bread
knife.
The detective can have had no idea of the relief I felt at having my theory
confirmed. I had probably sounded very sure of myself. And I was very
sure. But deep down I have, since childhood, recognized that life is a series
of unexpected twists and turns. This knowledge enslaves me. Although it is
my job to be certain, I was unable that day, and am still unable, to escape a
greater certainty: that there are always other possibilities.
20
By now I was beginning to suspect that my attempts to reconstruct
homicides from the track of stab wounds might just be eclipsed by a
technique which had recently appeared on the distant periphery of forensic
work. People had started to talk about DNA testing. DNA, they said, would
be a better means of identification than fingerprinting or any of our other
current methods. We discussed it in the pub during one of our raucous
office Friday lunchtimes, our debate leaking into the afternoon, the
secretaries and technicians all joining in. Was DNA the future? Or one of
those technological advances which would have no workable application
for years and years?
The new developments did make me wonder if my special interest in the
track of stab wounds would soon be so old-fashioned it would help no one.
My fascination with the idea did not abate but it happened that at around
that time another specialization seemed to find me. At first I tried to ignore
it, but somehow it managed to kick me hard in a vulnerable place I scarcely
knew I had: my social conscience. I did think I already worked for society:
forensic pathologists helped families and state to understand the dead and
so find justice, didn’t they? I was rather slow to take on board the idea that I
personally might have a more direct role to play in bringing about social
change.
Working closely with the police at the scene of a crime was a part of my
job. Their professionalism and camaraderie made the chaos, blood, filth and
human tragedy of the average homicide a lot easier to deal with. When I
had a good relationship with the officers involved they sometimes kept me
informed as their investigations progressed, and I valued that.
How hard it was, then, to bear witness to another sort of policing. One
that had little in common with the dignified, serious men and women I
encountered.
On arriving at a hospital mortuary for a post-mortem one night, the
information I was given at the briefing was a bit sketchy. I soon gathered
why. The patient had died while in the care of the prison system. I noticed
that there was no banter or small talk as we changed and walked into the
post-mortem room to examine the body.
The deceased was a twenty-eight-year-old Nigerian. An external
examination revealed abrasions on the front of his nose and around the lips.
I saw he had recent bruising to his arms and particularly around his wrists,
as well as on his abdomen.
I said, ‘So was he wearing a body belt when he died?’
They nodded glumly.
A body belt is an unattractive contraption consisting of a thick, heavy,
leather belt with handcuffs passing through a ring on each side. The belt, of
course, goes around the abdomen and the wrists are attached to it by the
handcuffs.
When I examined the deceased internally I found that he had severe
atheroma (furring up of the arteries) but only in one place: inside a carotid
artery, the main artery in the neck that takes blood to the brain: very unusual
in a twenty-eight-year-old. In a few years’ time that might well have
become life threatening. But it certainly did not cause his death.
Further tests showed that he also had sickle-cell trait.
Sickle-cell disease is the UK’s fastest growing genetic disorder. It is
carried by millions of people worldwide, mostly of African or Caribbean
origin. Those who suffer from it are more likely to survive malaria (not very
useful in metropolitan London). But that’s the end of the good news. It is
caused by a mutation in the haemoglobin gene and haemoglobin’s vital
function is to transport oxygen around the body. In healthy individuals with
normal haemoglobin, these red blood cells are fat and round with a dimple
in the middle – not unlike a ring doughnut. And, most importantly, they are
bendy. The sickle-cell genetic mutation swaps one amino acid and this
means that the haemoglobin folds differently. For most of the time that’s not
a problem but when the haemoglobin molecule is not holding on to an
oxygen molecule it can become stiff and fixed in an unusual shape. In this
case, red blood cells can look like odd bananas – or sickles, hence the name
of the disease. The result of the stiffness and strange shape is that, instead of
flowing smoothly through the blood vessels, the blood cells tend to pile up,
interlock and block the vessels – starving vital organs of oxygen.
Pains in the joints and abdomen and often anaemia are just the start of the
problems these blockages can cause. Sufferers were once virtually
guaranteed a short life but increasing knowledge of the disease and new
drug treatments are changing all that, and maybe gene therapy will soon be
available to help further.
The full, severe, disease means that the individual has inherited the same
faulty gene from both parents. This is called homozygous and, as a result,
sufferers can only make the faulty haemoglobin. However, inherit one
faulty gene from one parent and one normal gene from the other and
sufferers are called heterozygous. They can make some normal
haemoglobin as well as some faulty haemoglobin. These individuals will
have the lesser form of the disease, which, not surprisingly in a genetic
disorder of this sort, is even more widespread than full sickle-cell disease.
This is called sickle-cell trait.
Sickle-cell trait was for a long time thought to have no significant impact
on those who had it (unless they caught malaria). Only in recent decades
has it been recognized as a major risk factor in certain circumstances. And
those are circumstances that in any way significantly deprive sufferers of
oxygen. So, no climbing Everest for those with sickle-cell trait. In fact,
sickle-cell trait sufferers should avoid all situations where there may be any
threat of oxygen deprivation at all, so as well as climbing high mountains,
that includes scuba diving, parachuting … and being forcefully restrained.
Of course, the former are a matter of choice. But not the latter.
This was the first case for me, although soon others followed, in which a
black patient died under restraint and in whom I could find only a few
sickle cells in the tissues when I looked down the microscope. This
indicated that they did not have full sickle-cell disease but sickle-cell trait,
and this could then be confirmed by specialist tests on their haemoglobin.
Sadly, many probably did not even know that they were carriers.
This particular patient also showed signs of hypoxia, which is a lack of
oxygen. He had been forcibly restrained but none of his injuries was
actually life threatening. Clearly, then, the police actions must have gone
further than was indicated by the areas of bruising, all of which I noted
carefully in my report.
It was only later that I was given the full story. He was being held at a
London jail awaiting trial for conspiracy to defraud. I’m not sure what he
did for his behaviour to be described by prison medical officers as ‘strange’
enough for them to arrange his transfer to the hospital wing of Brixton jail. I
think from that I would assume mental health problems, although none of
the medical notes specifically said so. I didn’t think that this behaviour was
drug-related since, although cocaine was found in his urine, it was very
minimal.
During transportation to the hospital wing at Brixton he became ‘agitated
or aggressive, then unresponsive’. That description comes from notes taken
by the doctor at the accident and emergency department when the patient
was driven there later. According to the police’s own records, on arrival at
Brixton Prison’s hospital wing ‘it was noticed that he appeared not to be
breathing’.
So he was bundled into the back of a van and taken to A&E. He was
given CPR on the way but those resuscitation attempts were not successful.
In fact, the A&E doctor’s notes added, ‘fingers stiff!’
It seemed to me that he may have been held in a way that restricted his
breathing and his oxygen supply – possibly face down, or maybe someone
knelt on his chest. But the post-mortem showed that death was caused
primarily by the fact that he had severe pneumonia.
This was enough to slip him out of the suspicious death category. He had
died from natural causes – a combination of pneumonia and sickle-cell trait.
Although I felt and said that he might have survived pneumonia if he had
been given proper treatment immediately and if he had not been restrained
in a body belt face down, or in some other position that further restricted his
ability to breathe.
The deceased was of no fixed abode and he may, therefore, have been
living rough and contracted pneumonia before his arrest, or he may actually
have contracted it in custody. An inquest was held and a verdict of death by
natural causes was given – aggravated, the coroner said in something of an
understatement, by lack of care.
This took place less than thirty years ago but in those days in general –
and this is not true of all communities – the bulk of society thought
criminals deserved what they got, and that the police were always, or at
least usually, right. So, even without the natural and mitigating factors of
his sickle-cell trait and pneumonia, there would have been no outcry at the
death of a prisoner. And I am sorry to say that, the times being what they
were, such indifference was especially true if the prisoner was black.
Indifference from both public and police meant there was an almost total
lack of training and understanding about how and when to restrain someone
safely. Such training was not considered relevant or useful for the day-today work of a policeman or prison officer. It was acceptable for staff simply
to rugby-tackle people, jump on them, wrestle with them, do whatever was
necessary to get them under control – and ‘control’ meant ‘still’.
Police and prison officers were trusted to do what was right and the
nation was uncaring about the possibility that they might not. I, however,
could not share this attitude. I saw a series of deaths in custody or under
restraint. Many of the dead were black. This was not just a sickle-cell
problem, although it was sickle-cell that had brought it to my attention. I
felt that I had to do something. But what? I worked with the Met and good,
supportive relations were essential at the scene of a crime and afterwards. I
liked and respected many officers. A pleasant working relationship with
them was essential to me and so I did not know how to call them on their
behaviour. But I knew I had to, and as the deaths under restraint were more
than occasional, I realized that I had to focus on this. I just wasn’t sure yet
how to use my knowledge to improve the situation. After all, pathologists
examine bodies and understand the cause of death. Our findings might
contribute to the saving of future lives or the process of justice. But it
wasn’t my job to change the world. Was it?
21
I could not ignore the problem of death caused by restraint but,
intellectually and analytically, I remained committed to studying knife
murders. As a bullets-and-bombs man, Iain West had specialized in a
comparatively straightforward area. The perpetrators want someone dead
and they shoot them, end of story. Stab wounds require perpetrator and
victim to be up close and personal. Stab wounds often involve mixed
motives. Stab wounds may have more to do with a sense of theatre than a
definite wish to kill – particularly if the injuries are self-inflicted. But what
really interested me was my theory that every wound track tells a story. I
was still sure that the exact track a knife made into the body – and often
victims are stabbed many times – could provide a sort of photograph of the
homicide itself if one knew enough about wounding.
At each knife murder I was anxious to learn anything I could from the
wounds. Very soon after the suicide of the old man with the bread knife
came another death by knife. It was an entirely routine homicide but it did
show me that all those experiments with the Sunday roast were getting me
somewhere.
Winter followed quickly behind that sunny autumn day, and soon the first
frost came. One morning, I was called to a body found by a canal in north
London. I arrived at noon to find a young man in jeans and jacket lying face
down in a grassy waste area, his arms beneath him. The temperature was
still only 2°C and this did not help the usual problems determining the time
of death. Body temperature was down to 20°C and the police photographs
showed that there was frost still on the body when found. Rigor mortis was
established but not fully fixed.
All I could tell the police from this was that death had occurred at some
time between midnight and 6 a.m. – eliciting the usual response of veiled
frustration.
The grass adjacent to the deceased’s feet was bloodstained and next to
the body was a bloodstained kitchen knife. I turned him over and saw that
the mouth, nose, hand and front of the chest were covered in blood.
We moved him to the mortuary for a full post-mortem, where I confirmed
that a single stab wound had penetrated first his clothes, then the cartilage
of three adjacent ribs. The cartilage had deflected the blade. Just a little, but
that small deflection meant sadly that the knife went straight into the aorta.
It had cut through the aorta to the trachea behind it. The track ended in the
oesophagus. The total track length from the skin surface was 12cm. The
incision went horizontally from front to back and slightly from right to left.
The black-handled kitchen knife found nearby would certainly have been
the right size and shape to cause this wound. The force used must have been
more than moderate as it had cut through both clothing and the three ribs.
There were also minor abrasions on the deceased’s face and various
abrasions on the left arm.
It looked like a straightforward stabbing. The police were trying to match
it to the defendant’s story. The defendant and victim, both aged about
twenty, had been drinking together and then went out for a walk. They were
good friends but, as revealed during his police interview, the accused was
secretly angry with his mate:
Q: What did you talk about?
A: Nothing really.
Q: Were you armed?
A: No.
Q: Was he?
A: Yeah, he always carries a knife.
Q: On previous occasions have you both carried knives?
A: Yeah, but mine was at home then.
Q: I must tell you that you are still under caution. Do you know how he died?
A: I think I do.
Q: Please tell us.
A: We reached the canal and he said he felt sick. So I stood there and waited for him and I
looked down and saw my trainer was undone so I bent down to retie my lace and he
said, what do you think of me going out with your sister?
Q: Mary?
A: Yes.
Q: How old is Mary?
A: Thirteen.
Q: What did you say?
A: I said I didn’t like it very much because she’s only thirteen. I looked up to face him
and ask him why he was asking but I didn’t have time, he was drawing something
from his clothing. I thought he was going to hit me. So I panic and I push him then I
turn and run. I turned round once and saw him stumbling backwards. I carried on
running. I didn’t know he was hurt or I would have gone back and helped him.
Further questioning revealed how upset the young man was at the
possibility that his friend was having sex with the thirteen-year-old Mary.
After one of many breaks, during which he conferred with his solicitor, the
accused said, ‘If it’s the knife I think it is then I saw that in his flat. It had
fallen out of the plate rack with a load of others and I picked it up and put it
on the worktop.’
The solicitor later asked once again for a few words alone with his client
who, on re-emerging, admitted to causing the death – but insisted it had
been an accident: ‘He was my best friend and no way did I mean to hurt
him, that’s it.’
I was sure that the defendant’s version of events was false. My own
instinct told me that it would not be possible to turn around a knife held by
someone else and penetrate the chest with it in this way – the wound was
straight and horizontal. And certainly not to penetrate so high into the chest
from a low, crouching position.
However, on the basis that the defendant was innocent until proven
guilty, I tried re-enacting the scene at home. I crouched on the floor
pretending to tie my shoelace (with my right hand), look up, and deflect an
assailant’s approaching ruler (standing in for the knife – which I held in my
left hand) into the assailant (a pillow on a chair) and cause a horizontal,
straight wound. I had just got the ruler into the pillow when I realized that
someone else was in the room.
I turned around. Chris had come into the study. Both children had been
taught to knock so that they wouldn’t stumble upon any upsetting material.
I must have been so engrossed that I didn’t hear him. Now he was staring at
me rather awkwardly.
‘Yes?’ I said, trying to look as if this was all perfectly normal.
He was clutching a schoolbook.
‘What are you doing?’ he asked in a voice which required some
explanation. He was nine now and a relaxed, even-tempered child who
seemed in no way related to the screaming baby emperor who had tortured
us for nights on end.
I stood up. Honesty was probably the best policy.
‘Well, I’m trying to see if a man tying his shoelace … that’s me, here,
with my right hand … if another man came at him with a knife … that’s me,
too, the other man is my left hand and the ruler is the knife … if the first
man could somehow turn the knife around and stick it into the second man,
all while he’s crouching down.’
Chris considered this wisely.
‘Yes,’ he said at last. ‘I think he could.’
‘Thinking isn’t good enough. The first man could be sent to prison for a
long time – so I have to be sure.’
‘Did the first man kill the second man?’
‘Well … yes.’
‘Have you seen him?’
‘The first man? No.’
‘The second man.’
‘Yes, Chris, I’ve seen him in the mortuary. I’ve examined his wounds and
I know that the knife went into him at a certain angle, in a certain way. I’m
trying to see if the first man could have done that when he was attacked
while he was tying his shoelace.’
Chris nodded. I was not sure he really comprehended what I was saying.
He just accepted that his father did some strange things.
‘I came to show you my biology book. I got the highest mark of anyone.’
Of course! My son was here for a reason. And I had been so engrossed I
had told him about my work without even asking what that reason was. We
looked at the biology book together and I exclaimed with great parental
pride over his run of As and eventually Chris left looking cheerful and I
continued my experiment. Despite trying very hard, I simply could not
contrive a way for a crouching individual to deflect or push a knife held by
an assailant into the assailant’s chest – not if the result was to be such a
high, horizontal track into the pillow. I mean, body. As I had strongly
suspected, this case was a straightforward (in both senses), standing
stabbing injury.
There was a small knock at the study door.
‘Daddy, we both think he did it,’ said Anna, bursting in.
‘Who did what?’
‘Well, Chris was the first man, tying his shoelace and I was the second
man, coming at him with a knife and –’
‘You didn’t use a real knife, did you?’
‘No, I used my pen. Anyway, Chris easily turned it round and stabbed
me, so we think the first man is a murderer.’
‘Right. Well. Thanks.’
‘Shall we show you? Or if you like, you could be the first man and I’ll be
the second man, I’m better at this than Chris.’
I felt that Anna, who must only have been seven years old, should not
really be helping me reconstruct a homicide. If she ever caught me with a
knife she tended to regard it as a bit of a joke. She responded to the idea of
dead bodies as something unsavoury but the full meaning of death was still
lost on her and she had certainly not seen a body, not even a photograph.
Not only were the children taught to knock on the study door, I always
carefully hid any police pictures on a high shelf.
‘Just what game are you playing with the children!’ demanded Jen,
appearing from the living room, her face thunderous.
‘No games, Chris came in, so I told him what I was doing.’
Jen rolled her eyes.
‘I leave my work at the hospital,’ she said pointedly.
Chris and Anna eventually would understand fully what my job entailed
but, for now anyway, they were told simply to inform anyone who asked
that I was a doctor. They had picked up the fact that I was a specific sort of
doctor, that I helped the police and that my name appeared in the
newspapers, but they had no real idea what a forensic pathologist was.
Although around about this time they began to realize that my speciality did
not make people ‘better’. In our household it was fairly normal for Dad to
stick rulers and knives into pillows and pieces of meat and, so far, Chris and
Anna seemed not to have realized that other people’s fathers didn’t do that.
Today, the defence team in that stabbing case by the canal might
successfully offer a manslaughter plea of loss of self-control. A post-Savile
jury might decide that seeing ‘a red mist’ because your friend was sexually
imperilling your thirteen-year-old sister is enough of a trigger. There were
plenty of statements from family members that confirmed how upset and
furious the brother had been at her possible abuse by his friend.
For the modern defence of loss of self-control, it must be proved that a
person of the defendant’s age and sex with a reasonable degree of tolerance
and self-restraint, would lose control in a similar way. I think the young
man would have had a good chance of showing that. But for loss of control
the defence must also prove that there was no premeditation. The pitfall for
this defendant would be that the murder might have appeared premeditated
if he had actually carried the knife to the canal that night. He had explained
why his fingerprints were on the handle but he would have had to persuade
the jury that the victim had been the one to take the knife from the kitchen
before they went out for their walk.
This homicide happened long before the reforms of 2010, in less
enlightened times. Loss of control was not a defence. There was then no
hope for the young man who was so anxious to protect his sister. The
charge was murder and he was found guilty: an open-and-shut case in the
1980s.
A routine murder, but one in which the precise angle and track of the stab
wound provided important evidence. And it very often does. Not just the
track, but, once the knife is in the body, its subsequent movement inside an
organ can sometimes chart the respective movements of victim and
perpetrator. As my casebook thickened, I became increasingly convinced
that knife wounds could tell all, if only we could hear what they were
saying. I wanted to compile a really comprehensive analysis of tracks,
angles, hilt bruises … I was always rooting around in the kitchen at home
for another knife to stick into another piece of meat. In fact, I bought so
many knives of different shapes and hilts that, going home at night, had the
police been in the habit of stopping and searching middle-class, white men,
I could frequently have been arrested for carrying offensive weapons.
To the continued disgust of my family, I now used pork bellies or cow
kidneys for my stabbing exercises. It was extremely hard to reproduce quite
the feel of pushing through human skin, muscle and then an internal organ –
perhaps because supermarket meat is seldom fresh. In reality, people who
have killed with a knife are usually astonished by how easy it is. Once the
blade has cut through the clothing and the skin, the inner body tissues put
up little resistance. Only moderate force is required to penetrate major
organs like the heart or the liver, and so even perpetrators with little
strength can kill by stabbing. A lot of murderers say, ‘I didn’t mean to kill
him!’ What they are actually saying is, ‘I didn’t think that what I was doing
would kill him.’ And this is more likely to be true when knife murderers say
it than others. Knives give the murderer an immense advantage over their
victim even if the victim is much stronger. No wonder women so often turn
to them.
And did I prove, after all these experiments, that it is possible to read the
history of a murder by reading the stab wounds like a book as I had hoped?
Well, no. But I did find knives could tell a lot about a homicide. I developed
the ability to sketch a murder weapon with some accuracy, based on the
track it had left in the body. And when the police offer me a series of
possible murder weapons, I can exclude most and, if the right one is
presented to me, generally pick it out.
22
Just eight months after the Clapham rail disaster I took a call early one
Sunday morning to warn me that there had been another disaster. It was
August and Iain was on holiday and I was the forensic pathologist in charge
of London and the south-east of England. At this stage, no one knew how
many bodies there would be but one thing was certain: there would be
bodies.
This time catastrophe had occurred not on the railway but on the River
Thames. I waited for more news before setting off and my first stop was the
Police Pier in Wapping. A leisure boat had sunk somewhere near Southwark
and bodies recovered from the vessel were here. That was all I knew.
An old police sergeant greeted me and to my astonishment he was close
to tears.
‘Almost got my thirty years in, Doc. And now there’s twenty-five dead
from the river, twenty-four on the boat, another one picked up this morning
eight bridges upstream at Vauxhall. Never thought I’d see anything like this.
They’re all kids. Kids in their twenties.’
So the boat that went down must have been one of those party vessels,
the sort people hire to cruise up and down the Thames. I had seen them and
heard them many times. Young people on the deck, clothes fluttering under
the lights like giant moths. Laughter and music discernible from either river
bank. Through the windows, the shadows, colours and movement of a
dance floor.
The sergeant added, ‘Doc, the police surgeon’s already been in and
certified them all dead.’ And now he really began to cry, walking away,
shaking his head. I heard him blow his nose before opening the door and
going back to the front desk to fend off the press.
Wapping Police Pier is a Victorian police station standing right beside the
river. At the back, an area had been designated the temporary mortuary. It
was just a room, really. Its concrete floor was nearly covered by body bags.
All of them lay open and in each one lay the body of a young adult. All
dressed for a party, many in bright colours. I looked across this devastating
scene and I noticed something strange. Their clothing had been disturbed.
Dresses were displaced, trousers opened …
I immediately went back out to the sergeant. He grimaced.
‘Police surgeon opened all the clothes. Think he might have been
checking what sex they were.’
I wasn’t pleased but there wasn’t much I could do about it now. Probably
they had been overwhelmed by events and had needed to feel that he was
doing something, anything, useful: check pulses, listen for heartbeats. I had
seen this sort of reaction before – even highly trained professionals want to
‘do something’, when they know full well that the correct thing to do is
absolutely nothing.
I then went to Westminster. I knew the deceased wouldn’t stay long in the
temporary police mortuary. I wanted to ensure that Westminster mortuary
was prepared for the large number of bodies that was about to hit them.
Oh no. I remembered that the usual manager, Peter Bevan, was on
holiday. His deputy was in charge and I had never found this man to be
anywhere near as organized or efficient as his boss. Peter’s calm, capable
organizational skills were exactly what we needed when managing a mass
disaster. However, at least the staff were busy preparing for the huge intake
and all the post-mortem tables and necessary equipment were ready. The
sight of these preparations gave me, for the first time, a sense of dread that
was something close to nausea. It was fleeting. But powerful.
With another pathologist under my supervision, I agreed to return the
next day when the bodies had been brought over from Wapping to start the
examinations.
Gradually, the facts emerged. On that calm summer night, a huge dredger
had collided on the Thames near Southwark Bridge with a small pleasure
boat called the Marchioness.
The Bowbelle had dumped its cargo of gravel at Nine Elms and was
proceeding back out to sea to dredge for more. The Marchioness had been
hired to celebrate a birthday and an international crowd of young people
was partying on board.
Initially, the Bowbelle hit the little Marchioness at the back on the
starboard side. This caused the pleasure boat to rock and keel over: a
witness said the Bowbelle then ‘mounted it, pushing it under water like a
toy boat’. In fact, the anchor of the dredger cut right through the pleasure
boat’s upper deck before a second impact pushed the back of the
Marchioness round to starboard, causing her to roll over.
Here are some survivor statements:
I felt a jolt … then I noticed the stern moving out in a starboard direction … I saw water
come through the open window. I felt the boat keel over … I remember turning around to
head towards the windows to escape … as water started coming in … I knew the boat
was going to go down. Within a matter of seconds, the lights went out. Everything was in
darkness … I was then thrown forward by a wall of water. The whole boat filled instantly
… When I surfaced I was some distance away from the Marchioness, which was partly
submerged …
I … felt the right-hand side of the boat … dip down suddenly … As the boat tipped over,
water came flooding in through those open windows on the right-hand side. Everybody
who had been on the dance floor lost their footing and with me and chairs and everything
moveable went sliding down to the right, down into the water which was filling the dance
area incredibly fast. I went under water …
Suddenly the boat tilted onto its side and the toilet began to fill with water. I tried to
unlock the door and get out. When I managed to get the door open the boat was
completely submerged.
I felt the boat rock, then it all of a sudden sort of swerved round and I lost my balance. I
think I fell against a table … I saw this hull coming through the boat, I saw this anchor
coming in, glass started breaking, all the windows smashed and showered us with glass,
water started pouring in …
A terrifying ordeal for the young people on board. All passengers’
chances of escape were hampered by the great speed of the sudden rotation,
loose furniture, darkness, the cold, turbid water and, for some, the lack of
accessible emergency exits. The result was that, to get away, physical
exertion and strength were required. Which compromised the survival
chances of many.
A much later statement on the disaster made by Dr Howard Oakley, an
expert on survival and thermal medicine, said, ‘Sudden capsize is known to
be a shocking experience, to which individual reactions would have varied
from panic to calm determination to escape and survive … physiological
responses to that shock are likely to have shortened the time for which
victims could hold their breath, which would in turn have reduced the
chances of successful escape.’
Within thirty seconds of impact, the Marchioness was lying at the bottom
of the Thames. Fourteen vessels helped to rescue the living. But not for
several hours, at least, were the dead retrieved. Many of the dead were
probably trapped on the boat. Others must have been thrown overboard.
The Thames is a treacherous river, deep and dark, with a rich mixture of
currents and tides which are known to hide bodies for days and even weeks
before giving them up. In fact, it was five hours before the first body from
the Marchioness was found in the river. And almost two weeks until the
Thames yielded the last one.
A drowned body – or a body which is immersed in water after dying
some other way – will first develop opaque, wrinkly skin. Anyone who has
spent too long in the bath will have an idea what this looks like. It is often
called ‘washerwoman’s hands’: the thick keratin layers on the fingers, the
palms and the soles become macerated and the skin appears very white and
wrinkled, whatever the ethnicity of the deceased. After a few days, if the
body remains in the water, this macerated skin will begin to separate and it
will, eventually, peel off.
I should also say, because it is relevant to what happened next, that the
time it takes a body to float to the surface depends on the gas in the bloated
and decomposing body. Generally, the obese surface fastest.
The Marchioness went down shortly before 2 a.m. on the morning of
Sunday 20 August. By the end of that day, although I had, with a colleague
from Guy’s, viewed and organized the bodies, we still had no idea how
many people on board had died. There were clearly a lot of survivors so we
were harbouring hopes that there might be few further bodies.
By law, the coroner is in charge of those bodies and Westminster’s
coroner, Paul Knapman, came back to London from his holiday in Devon
and met with me and senior police officers to agree how we would process
the dead. As coroner, he had to establish positive identification of the
bodies, and we discussed how he wanted to do this.
In mass disaster management, false identification is the biggest fear. This
is obviously hideous for everyone, especially if a family later begins to
suspect they may have buried the wrong body. The coroner rightly wanted
the most secure and accurate identification methods that were possible.
Now we have the option of DNA analysis but, although the subject of much
pub discussion, DNA identification was just not available to us then. The
two most secure means were still fingerprints and comparison of teeth with
dental records.
The problem with dental records is that you, of course, have to know the
name of the missing before you can begin to search for their dentist, and
only when the name of the dentist is known can you request their records.
And then that request can take a very long time to fulfil. This is especially
true if records must come from other countries. And by now we knew that
the partygoers on the Marchioness were a high-flying crowd from all over
the world. That was clearly going to cause problems and delays.
As a result of all this, fingerprinting was the first choice of identifier.
Fingerprinting plus dental records would be ideal. Absolute accuracy can be
a time-consuming business, but the coroner took the view that accuracy was
more important than speed. Which is surely correct, although I can
understand this is very frustrating for anxious relatives.
Those who are trying to cope with the possibility of sudden bereavement
after a mass disaster often cannot understand why the relatives are not
simply invited into the mortuary to walk through the lines of fatalities to
claim their loved one. Many relatives of the Marchioness victims, believing
that identification must be easy, did in fact suggest that, if they could just be
allowed into the mortuary, they could find their family member. I
understand their need and their logic, but it is false. And it would have been
utterly inhumane to allow this.
People find it hard to believe that, in mass disasters, visual identification
is unreliable, especially so when death has been traumatic or the body has
been immersed in water. But even the uninjured and undecomposed dead
are often simply not recognizable to those who knew them as animated
individuals. Without life, facial expression, movement, robbed of our
essential selves, our bodies can look very different. And this is certainly the
case when the dead have been held by the Thames for hours or days.
The fact is that relatives, even immediate family, when they are under
great stress, are very likely to make mistakes. They may identify a body that
isn’t their relative. Or they may not correctly identify a body that really is
their loved one. These are known as false positive or false negative
identifications, and they happen more often than you might think. Later,
perhaps much later, the identifying relatives sometimes worry they were
wrong. And then change their minds. This can occur long after burial or
cremation, when our ability to review the identification is lost. Add to the
difficulties of identification the immense emotional trauma of having to
look at many, many bodies in the mortuary to find the one you think may be
your relative. With all my experience of death and dying I know I couldn’t
walk between rows of victims and reliably identify my own wife or child or
parent.
I should say that being called on to see a body for identification purposes
is quite different from seeing that body once police and pathologists are
sure that the correct identification has taken place. I personally believe
every relative who wishes to do so has an absolute right to see the body of
their deceased. It is cruel to deny – for whatever reason – a family this
chance to say goodbye personally. But the reality is that bodies may be
injured, decomposed and smelly. We can do a lot with reconstruction, but
we can’t perform miracles. So it may take many hours of talking and
discussing, of initially showing photographs of the body, before we can
move into the room where the body lies. And then maybe more time again
before the relatives will actually look at the body. Spending this time with
families is crucial. So is care and compassion. We must do nothing to add to
the trauma.
As unreliable as visual identification is the use of ‘mobile’ or moveable
indicators, such as clothing, jewellery or wallets. These may be treated only
as clues to identity because people swap jewellery or look after friends’
wallets. And to use clothing, we would have needed to know exactly what
the victims were wearing on the night of their death, relying on descriptions
from others when such descriptions are seldom either accurate or available.
Despite this, the coroner was inclined to accept visual identification and
mobile indicators – but only from those bodies recovered from the wreck of
the Marchioness itself, and only as long as they showed no decomposition.
In all other cases, the coroner instructed that mobile means of identification
were not dependable.
The coroner’s conclusion, when we discussed identification, was that
fingerprinting of each body was essential. As a list of the suspected missing
was compiled, police were despatched to homes (unless they happened
already to have fingerprints on their database) to collect personal items on
which fingerprints might be found, so that these could be used to match
those taken in the mortuary.
Our problem was that these were drowned bodies. They were likely to be
damaged, either by aquatic predators or by contact with rocks, bridges,
boats or other underwater obstructions. Drowned bodies show all the
discolouration and bloating of normal decomposition plus some much
earlier skin changes. Even if retrieved from the water within a few hours,
those inevitable ‘washerwoman hands’ can make fingerprinting difficult,
and when there is a complete loss of the skin from the hands – elegantly
called ‘degloving’ – well, then it can be extremely difficult or almost
impossible to take fingerprints from the deeper layers of skin, the dermis.
At first this disaster seemed easier than Clapham because there was no
severe mutilation of the bodies. As time went on, however, bodies arrived in
worse and worse condition and decomposition became our nemesis.
Once again, each body travelled through a system. First, we described in
detail clothes, jewellery and general appearance. I then helped remove the
clothes and performed an external examination, describing tattoos, scars
and anything unusual that might assist identification. Police officers made
notes and the body was photographed and refrigerated.
The second phase was the full post-mortem, after which the internal
organs would as usual be replaced in the body cavity and the body sewn up
and made presentable for viewing by relatives.
Finally, I submitted a report about each of the deceased for the coroner,
concluding with the cause of death: drowning. If he was satisfied with all
this, especially the identification processes, he would open an inquest and
release the body.
The first free-floating body was found in the Thames before 7 a.m. that
Sunday morning. No more were found that day but in the afternoon the
Marchioness was raised and when I reached Wapping police station,
twenty-four had been found on board and arrived at Wapping in the warmth
of an August day. They were tagged before being carried on to Westminster
mortuary.
This mortuary is run by Westminster City Council. At that time, it had six
holding fridges, refrigeration for sixty bodies and a further six units for
extra-wide bodies. It had freezing facilities for eighteen bodies.
Whatever the outside temperature, bodies are refrigerated to a
temperature of 4°C. This slows down the decomposition process but does
not stop it completely. We do not freeze bodies until the post-mortem has
been fully completed.
During a disaster, we work in a world of constantly changing
information, often helping to revise and then re-revise it. The key problem
for those managing the Marchioness victims was that no one had any idea
exactly how many people had been on board the boat, nor who they were.
So, within a couple of hours, while the rescue operation was still going on
and before the first body had been found near Vauxhall Bridge, a telephone
bureau had been opened to process information from friends and relatives
that might help us identify victims. And by that afternoon, as Westminster
mortuary prepared for its influx of dead, relatives of some on board had
started to appear at police stations with photos of their loved ones and
descriptions of what they might have been wearing.
By the end of that first day, the police believed that there had been 150
people on the Marchioness, of whom sixty-five, including those twentyfour bodies taken from the wreckage, were considered missing.
The next day I was back at the mortuary starting the long process of
identification and post-mortem. We learned that eighty-seven survivors had
identified themselves and we had twenty-five bodies, so we knew that if
police estimates of the number of people on board were correct, there were
a lot more bodies to come.
Expecting so many further arrivals, we worked as speedily as accuracy
would allow. It was an extremely intense week. To see so many young
people here was not just unusual, it was shocking. I was aware, as though in
my peripheral vision, of the intense misery of parents fearing the worst,
waiting for news. Bodies were laid out one at a time on the six tables in the
post-mortem room and we worked our way doggedly from one to the next,
feeling the greatest service we could perform for the bereaved was to do our
job as efficiently as possible.
By eight o’clock that evening we had completed post-mortems on all
twenty-five in the mortuary and, of these, thirteen had now been fully
identified. The next day, Tuesday 22 August, we learned that the casualty
bureau had received 4,725 calls from anxious relatives and had already
amassed more than 2,000 documents on individuals believed to be on
board. As we waited, a few more bodies were found in various places on
the Thames, upstream and downstream of the disaster, and the police
revised their estimate of the number of people on board the Marchioness
down to 136.
By the end of the day there were thirty bodies in the mortuary and the
police thought there were twenty-seven more to be found. But by now,
immersion time in the Thames was taking its toll. Waterlogged skin was
falling off fingers and the officers were having trouble getting prints using
the standard inking process. The coroner called for dental records to help
confirm the identity of the remaining fatalities but this would take time and
relatives were anxious for news. So attempts to fingerprint continued but, as
the hours went by, conventional fingerprinting was failing. It was now
necessary to use a specialist technique and more sophisticated equipment.
This equipment was based in a laboratory in Southwark – which had no
facilities to manage bodies.
The routine process for individual bodies recovered from the Thames that
could not be fingerprinted at the mortuary was to remove the hands,
fingerprint them at the lab in Southwark, and then return the hands to the
body. They were sewn back on to avoid distressing relatives, who, when the
body is appropriately arranged, were unlikely even to see the stitches. The
coroner allowed this and so the procedure was followed. Seventeen pairs of
hands were removed.
That evening more bodies were found between Westminster and London
Bridge, and then another, far downstream past Wapping. The next day, eight
more bodies were found. One, retrieved at Cherry Garden pier on the south
side of the river at Bermondsey, was wearing uniform and strongly
suspected to be the Marchioness’s captain, Stephen Faldo. Another was
nearby, then four more were found near HMS Belfast, not far from London
Bridge. Two more were on the other side of the wreckage, upstream around
Westminster.
That gave us a total of forty-four bodies. By now we had positively
identified twenty-four of these. Of course, there was an assumption that
every single body found on the river must be from the Marchioness, but this
was unlikely to be the case: there are suicides and other deaths in the
Thames almost weekly, and we had to be aware of this.
By the following day there were forty-eight bodies and, although we had
been working as hard as we could, six were still waiting for post-mortems.
The police were saying they now believed there had been 140 people on
board the Marchioness: eighty-four survivors and fifty-six lost or missing.
The dental records of all the known victims had been requested, those from
abroad via the relevant embassies. That night, Wednesday, the casualty
bureau closed, saying it had gathered all the information about the missing
it could.
However, bodies were still being found and the police revised their
estimates again. They thought there were eighty-three survivors and fiftysix lost or missing. But there was now a report, for the first time, of a fiftyfour-year-old woman running the disco on the boat. This was followed by
another report of a woman jumping into the Thames near HMS Belfast after
a handbag full of bricks was found on the riverbank. As we carried out our
post-mortems, some officers began to grumble at the way the casualty
bureau had closed when so many inquiries were still outstanding. And by
Thursday evening, there was a new development that pushed police
estimates of the number of people on board up again: a group of
gatecrashers at the party came forward to say they had survived the sinking
– but a friend was missing.
Meanwhile, back at the mortuary, a request was sent to the lab for the
return of the seventeen pairs of hands as soon as possible so that they could
be reunited with their owners. Another eight pairs of hands were delivered
to the lab.
There was not much more we could do now but wait. It was the Friday
before the August bank holiday. Outside the mortuary, people were leaving
hot London for the weekend. We were waiting for dental records to arrive,
fingerprint information from the labs, or just more bodies: fifty had now
been recovered. After all that frantic activity, the mortuary seemed almost
eerily quiet.
No new bodies arrived in the mortuary over the long weekend. On the
Wednesday, the police attempted to name the people still missing. One of
them was the party’s host, Antonio Vasconcellos, who had been celebrating
his twenty-sixth birthday. Another was a Frenchman. And there was still
one unidentified body in the mortuary, a man in his twenties: he may have
been nothing to do with the Marchioness. Or he could be the gatecrasher,
who had still not been named.
By the end of the week, forty-six of the fifty bodies in the mortuary had
been positively identified and the others partially identified, meaning that
we still needed more information to make it positive. Except for this one
anonymous young man. Who was he? Nobody had any idea. He fitted no
description.
Since he was carrying a distinctive key fob, the police photographed it
and decided to release the picture to the press. So we had one person
completely unidentified, and still two missing people: the Frenchman and
Antonio Vasconcellos. We could stop worrying about the gatecrasher,
though: he had shown up alive and well.
On Friday there was a major step forward in the identification of the
mystery man. The distinctive key fob was taken to the Frenchman’s flat and
it opened the door there. Now only the party host was missing. That night
the body of a young man was found downstream of the wreck, between
London Bridge and Bermondsey, somewhere in that area broadly known as
the Thames Upper Pool. We were fairly confident this was Antonio
Vasconcellos, but after two weeks in the water we knew it would take some
time to identify him positively. We were also confident that the other bodies
in the mortuary were nothing to do with the Marchioness and the police
were sure now that there were no more dead. The toll was fifty-one and
there had been 137 people on board.
We had worked hard and, I felt, had served the victims and their families
well. Only afterwards did I understand that, while I had been immersed in
my work at the mortuary, a lot more was happening inside and outside it
than I realized.
Everyone responds rapidly and wholeheartedly to an emergency.
Everyone does their best at the time. So, although everyone, no matter how
well meaning, should be held to account, it is hard to receive criticism
afterwards for actions that may have been taken under extreme pressure in a
crisis. The emergency and follow-up services, after many of the 1980s
disasters I listed earlier, frequently found themselves on the receiving end
of some very angry criticism. It is such anger that very often fuels reform.
This is nowhere more true than after the sinking of the Marchioness.
I learned that, although some relatives early on identified their dead at a
special viewing room at the mortuary, many others were told, due to late
recovery of the body and the extent of the decomposition, they could not,
they were not allowed to, see their loved ones. Sad reunions of the living
and the dead do not usually take place at the mortuary: more often the body
is moved to the undertaker’s first. But undertakers, as well as the police,
later claimed they had been told such viewings should be strongly
discouraged and, even in the face of opposition, relatives should be refused
access to the dead.
I do not know who ordered this or why. When I learned of it, I assumed it
was the result of misplaced compassion, because someone thought that
seeing a son or daughter in a state of decomposition is traumatic. However,
that person clearly did not know that not seeing them is even worse.
One relative later wrote:
We were never actually prohibited from seeing [our daughter] but were talked out of
doing so at every stage … when I went to the undertaker’s expecting to see her, the coffin
was already sealed … I could not sit in a room with a box and so walked out of the
funeral parlour. I feel very strongly that I should have had the opportunity of time alone
with her. [Her mother] … has since seen photographs of [our daughter] and from the
photographs there really is no reason why we should not have seen her.
Another wrote:
On Friday 25 August I was told by the coroner’s officer that my son was not recognizable
as a human being. On Thursday, 31 August, the undertaker phoned me to say they had
collected [his body]. I went immediately to their premises and asked for the coffin to be
opened. I wanted to make sure that I had found my son. The undertaker told me that he
had been given orders not to let me view my son’s body. This made me extremely upset. I
was never given the opportunity to see him, to touch him and to say goodbye to him. The
undertaker told me that he had been an undertaker for twenty-five years and he had never
before been told that relatives could not view a body. ‘I was told the coffin was sealed
and it must be kept sealed,’ he said. Since it is the undertakers who place a body in its
coffin and they are the ones to close it, this was clearly untrue.
I still worry whether it is in fact my son who we buried. I think the root of this concern
is that I was never allowed to see him … there is an additional concern that the bodies
may have got mixed up … [Later] I looked at photos of his body. They were far less
horrific than I had expected … I could not help feeling ill at ease with how things had
been arranged … My concerns about whether I was ever given his body have meant that I
have, in the past, sought an exhumation order.
I had no idea why the relatives of the Marchioness victims had been
denied access to their loved ones: this seemed a cruel and unnecessary
decision. It was to be a few more years before further information emerged
to offer us – the relatives and those of us who had worked on the case – a
possible reason why bodies were not seen and coffins not opened.
23
Early autumn, 1992. Jen was now a doctor. She had graduated the previous
year and we had gone to her results night disco at the medical school bar,
where I, at least, had felt rather geriatric. And then decided to enjoy the
dancing. I was ridiculously proud of Jen but probably didn’t show it. And
maybe she was grateful to me for the support – the children, the house, the
bills – but she didn’t show that either. How hard it was to cross whatever
chasm lay between us. It was much easier to ignore it, especially now that
she was a junior doctor, working all hours, and I was so busy at Guy’s.
Today, for once, I was working from home. Children at school, nanny off,
Jen at the hospital. The daytime streets were quiet, much quieter than the
office. The room was comfortably warm: a dog flopped on each of my feet.
And the desk was littered with pictures of a homicide in which I was
completely engrossed.
On top of the post-mortem pictures and a book of photographs of the
victim’s clothes were the scene-of-crime photos. I could not forget that
rather grey July day. The urban wilderness of a large, south London park. A
path heavy with tree shade, lightened by the trunks of silver birches. The
POLICE DO NOT CROSS tape wound from tree to tree.
I saw something white in the grass, among the trees, which, from a
distance, you could mistake for a discarded handkerchief. As I neared the
handkerchief, a detective on either side of me, it grew larger and became
more dissonant with its surroundings until, by the time I arrived, the
contrast screamed between this green place and the human body which lay,
blanched, mostly naked, below shimmering birch leaves. A young woman.
Curled defensively. Stabbed many times. Her lower body naked. Sexually
assaulted.
I waited for the police photographers to finish their work before I took
her temperature and a few early swabs for semen. I felt her for rigor mortis
and found that only her jaw had set. Then I examined the scene, looking at
places where the ground had been disturbed, the detectives pointing out the
bloodstains on the grass, noting crushed leaves and broken branches where
there were signs of a struggle. This all took many hours. The body was at
last removed to the mortuary, where, watched by the same grave detectives,
I performed the post-mortem. In the comfort of my study now, I
remembered that long, long night. How it was dawn before every one of the
forty-nine stab wounds had been measured and documented, each track
traced through the internal organs it had penetrated.
I looked up. The clock ticked in the quiet house. I reached for the postmortem report and reread the conclusion. No natural cause had contributed
to the victim’s death. She had died of multiple deep stab wounds inflicted
by a knife or knives about 9cm long, about 1.5cm wide at the hilt. She had
struggled and had been stabbed right through her left hand as she tried to
defend herself. Once she was dead her assailant had not stopped stabbing
her. And once she was dead he sexually assaulted her.
There was immense public horror at Rachel Nickell’s brutal murder. She
was a beautiful, twenty-three-year-old mother who had taken her toddler to
Wimbledon Common for a walk. The nation’s shock put pressure on the
police to solve this crime, and solve it soon. So immense was this pressure
that the Met stepped outside its usual box. Officers talked to forensic
psychologists about profiling the killer. And they talked to me about
reconstructing the case.
I had all but given up hope of playing my part in a police investigation –
ever since my first careful recreation of a crime, that bedroom knife murder,
was spurned by the case detective. And now, for once, the police had come
to me and asked for a reconstruction. Specifically, they wanted me to piece
together the likely sequence of events that day, based on the evidence
present at the scene and at my post-mortem findings.
I had recently been inspired by a convention of American forensic
pathologists I had attended. For a while now I’d felt that, as a profession,
forensic pathology wasn’t developing much: we all rushed around on our
cases and discussed them in the pub, but that isn’t the same as development,
of ourselves or of our profession. I went to American conventions for a
different perspective and recently I’d found just that when I had learned that
American pathologists were now encouraged to be a bit more Simpson-ish
by participating in the investigation.
So I read through my own very thick post-mortem report on Rachel
Nickell. The wound details went on for pages. Three wounds, on the chest
and back, which I had numbered 17, 41 and 42, stood out from the rest.
They were the only superficial wounds in a victim who had been stabbed
deeply over and over again. Could these have been the first?
There is a moment at the very beginning of the chain of events which
leads to a homicide such as this when the perpetrator has to get close
enough to his victim to gain control. We know that establishing control is a
particularly important part of most sexual homicides. In such cases, we
often find wounds that are not deep enough to injure but scary enough to
make a victim comply with an assailant’s demands: these are ‘prodding
wounds’. Were 17, 41 and 42 ‘prodding wounds’? There was just one on
the deceased’s back – number 17 – while the others were high at the front of
her chest. I looked at them again. I wondered if she was first prodded in the
back. And then, did she turn to face her assailant?
In the scene-of-crime pictures, the most significant bloodstains were easy
to discern. They were not under trees but in a place where the summer grass
was left long and full of seeds, like a meadow. This was about five metres
from the place the body was discovered in the late afternoon by a shocked
mother with a toddler, dog and pushchair.
There was a second, smaller area of staining, much closer to the body’s
final position: it was adjacent to the forked birch tree under which the dead
woman was found. And, of course, there were bloodstains beneath the body.
It was safe to assume that the initial assault had taken place at the bloodiest
site, that the victim had been moved to the spot under the tree, and then
pulled a metre into that final position nearby.
Looking at the endless list of wounds, it was hard to decide which came
first, but the gaping neck wounds must have happened fairly early on as
they would have produced the most blood. That would also explain why the
victim apparently did not scream. Her neck had been attacked with force
and the pain would have been extreme. If that didn’t stop her screaming,
then the resulting damage to the muscles around her larynx would have
done so.
The pictures of Rachel Nickell’s clothes told me another part of the story.
Her T-shirt was wet with blood, of course. But her jeans, around and below
the knee, were muddy at the front. And blood-spattered at the back. I was
absolutely sure this could only be because she was kneeling early on in the
assault, while the initial injuries to her neck were inflicted.
Of course, with such injuries she could not have remained kneeling. She
must have fallen. It seemed likely she had fallen forward and that her
assailant had now stabbed her back – eighteen times in all.
Whichever way she fell, but especially if she fell forwards, her neck
would have bled profusely onto the ground. Is that why the killer moved her
to the second area under the tree? Or did he do this because by now she had
died? Or because he feared he could be seen too easily here on the grass?
The pictures showed less blood under the tree but the distribution was
wider. That is probably an indication she was lying here prone. I checked
the pictures of her body at post-mortem. Yes, leaf mould on her back. This
must, indeed, have been where he stabbed her front. If she was not dead
when he moved her, she must have died very soon after. Even so, he
continued to stab her body. In particular, he stabbed the heart and liver postmortem. They were penetrated, but the dead do not bleed.
Next, I noticed that the leaf mould on her back was also visible on her
buttocks. So here, under the tree, he must have ripped off her jeans. And
during or after this, her body was pulled over to be sexually assaulted in its
final, compliant position.
Did he continue to stab her afterwards? Or did he run off at once?
‘In my opinion, the minimum length of time needed to inflict all the
injuries would be three minutes,’ said my post-mortem report.
I knew that because, as usual, I had re-enacted the moves here at home. If
the murder had taken only three minutes, it certainly must have been fast
and furious. And it gave every appearance of a frenzied attack. Even the
coroner himself used this expression and the newspapers had certainly not
been able to resist it.
I had also spent hours analysing the knife wounds – some of which
showed evidence of the weapon’s square hilt on the skin because the blade
had been plunged in up to its maximum depth. And for the first time I had a
body part scanned. Magnetic resonance imaging showed the exact track of
the knife wounds in the liver. All this information meant that, although the
police had already presented me with a variety of possible knives, each time
I had confidently told them that, no, the wounds proved this could not have
been the murder weapon.
When I finished listing the sequence of last events in the life of Rachel
Nickell, a young woman whose name is widely known for the saddest of
reasons, I felt bone tired. World-weary. I looked at the clock. Almost time
to pick up the children and walk the dogs.
I switched off the computer and listened to the faint groan it gives when
extinguished. The dogs knew that sound and woke up simultaneously,
yawning and stretching. They watched as I locked the photographs of the
crime in my filing cabinet where no one, least of all a child, would stumble
across them.
Creating a reconstruction that really might help the police to find that
young woman’s killer did bring me great satisfaction. I would very shortly
be forty and this level of work represented the sort of contribution I had
always believed it was possible for forensic pathologists to make to
homicide investigations.
The dogs were wagging their tails, waiting to go. I did not move. I did
not want to come back to the here and now from this engrossing work.
Because there was something I had to do. Before dogs and children.
Reluctantly I picked up the phone and dialled one and then another in the
list of numbers I had made from the Yellow Pages.
‘Hello, am I talking to the undertaker?’
‘Yes, sir, what can I do for you?’
My father was dying in a hospice in Devon. He had advanced cancer and
was receiving terminal care. A couple of days ago I had said my sad
farewells there, as court cases and other commitments dragged me back to
London. My sister Helen had arrived to see him and then brother Robert. I
was making this call now, knowing that probably none of us would feel able
to when the right time came.
The voice at the other end sounded confused.
‘Sorry … I must have misheard. Did you say your father isn’t actually
dead yet?’
‘I’m afraid to say he soon will be, and I thought I’d organize things now.’
‘I see.’ Was that shock or disapproval? I felt embarrassed.
‘I’m actually a forensic pathologist so I … I work with death all the time
and I’m aware of the … the practicalities.’
‘Ah.’ My plea of mitigation had been accepted.
The formalities were therefore sorted out and, when the call came to say
my father was dead, I was released from mundane details and could allow
myself to grieve. Not to cry. Of course. But to feel the immense loss of my
good-hearted and much-loved father. He had somehow shuffled through a
long retirement in Devon with Joyce awkwardly by his side. My life had
not in any way revolved around him, but he was a constant presence. I
phoned every Sunday, he wrote every fortnight. Always there. Except now
he wasn’t. Something vast and unknowable seemed to gape at me. The
immensity of death, which I always managed to evade in the course of my
work, startled me by engulfing me now.
A day or so later I went to Devon and picked up the relevant forms from
the hospice to take them to the registrar of births and deaths as instructed.
The envelope said: Confidential. Do Not Open.
Naturally I ignored this. My life is spent dealing with confidential details
of the dead and these were my own father’s. As I waited at the registrar’s I
opened the envelope and studied the contents without a qualm.
A cold hand snatched the envelope from mine.
‘Just what do you think you’re doing?’
‘Well, I was reading the –’
‘If you can read, you will have seen that these notes are confidential. You
had absolutely no right to open them.’
My knuckles rapped, we proceeded to a small, shabby room for the
formalities. Except that I had already seen on the paperwork that the doctor
had given ‘Carcinoma of prostate’ as the cause of death. In the doctor’s
scribbled writing, it looked like ‘Carcenoma of prostate’.
I watched as the registrar, still stony-faced, laboriously wrote the death
certificate.
I said, ‘Excuse me … carcinoma is actually spelled with an i not an e …’
She looked daggers at me.
‘I … I’m a forensic pathologist. That’s why I was interested to read my
father’s notes and … well, I write the word carcinoma all the time and I can
assure you it is spelled with an i.’
The woman glared.
‘The doctor has spelled it with an e. It is my job to write the cause of
death exactly as it is given. Therefore, I shall write carcenoma because that
is how the doctor has chosen to write it.’
So my father’s death certificate, which I had to send out many times,
each time with a shudder of deep irritation, gave him a new and entirely
unknown cause of death, called carcenoma. It would have annoyed him as
much as it annoyed me. Although he would have enjoyed his unique place
in government statistics.
Two days before my mid-life birthday, the Shepherds gathered in Devon for
a much bigger event. Our father’s funeral. Here was Helen, who lived in the
north of England with her family. Here was Robert, who lived in France
with his wife. Despite the geography, we all remained close.
The night before the funeral, we had a family dinner with all the children
but, I am sorry to say, without Joyce. I hope this wasn’t unkind of us. I did
remain in touch with her for the rest of her life and took responsibility to
see that she was housed and cared for. But that night, we didn’t want to
censor any story about our father that predated her; we wanted to be free to
exchange anecdotes about that wonderful man and his own special
character. Not all of them were to his credit but all of them he would have
endorsed and enjoyed. We laughed a lot and drank his health and it was
truly an appreciation of his life.
To die greatly admired by your children is no mean feat. He had been the
eldest child in a large family and when there was not enough money for
education, and perhaps not enough love, to go round, he set out to create
both those things for himself and his own family.
Immersed in a sense of loss, but also of harmony and support among
Shepherds, we drove back to London, the kids in the back, me at the wheel,
Jen at my side grabbing the opportunity for some sleep because junior
doctors need all the shut-eye they can get. Another family, another
generation.
In fact, I felt some reluctance to leave Devon and go back to work. Guy’s
was a busy, stimulating, friendly place and I loved my job. But,
unfortunately, I’d run into turbulent waters lately. First, I was roundly
attacked by my colleagues for complying with the police request for a
reconstruction of Rachel Nickell’s murder.
‘You’re stepping right outside your area of expertise,’ they said.
I pointed out that, actually, I had relied entirely on my expertise for the
reconstruction. ‘And this is the way forensic pathology’s definitely moving
in America,’ I added.
They were unimpressed by the way forensic pathology was moving in
America. They shook their heads. They said, ‘When they arrest someone,
and the prosecution uses your reconstruction, defence counsel will slaughter
you in the witness box.’
By now I’d experienced enough public humiliation as an expert witness
to know this was probably true.
My other worry was the Marchioness.
That tragedy had occurred three years earlier, but somehow the wreck of
the pleasure boat kept resurfacing. Of course, the grief of those who had
lost someone in the disaster could never end – and right now their grief was
turning to anger.
We professionals might have thought it was over for us: some parts of the
rescue and its aftermath had not gone smoothly but the focus of attention
since the collision had been on its causes. There were many safety systems
that should have been in place on the Thames that night and weren’t, and it
was generally believed that the disaster happened because neither vessel
saw the other in time – because neither kept a proper look-out. However,
whatever the reason, the enormous Bowbelle had clearly ploughed into the
little Marchioness, and criminal proceedings had followed against the
Bowbelle’s master.
Victims’ relatives were furious that the master had been drinking heavily
the afternoon before the disaster as he waited for the tide to change so that
the dredger could head downriver. But experts (who didn’t believe that the
old RAF rule of eight hours from bottle to throttle had a marine application)
said the master had substantially slept off this alcohol intake in a nap before
setting off that night. So the charge against him was his failure to keep a
proper look-out.
The coroner was forced by the Director of Public Prosecutions to adjourn
inquests into the deaths until this criminal trial was over – but there never
really was a result. Two juries failed to reach a verdict on the culpability of
the master of the Bowbelle, and a later attempt to prosecute the dredger’s
owners privately also faltered.
After the Bowbelle verdict, or lack of one, the coroner decided it was not
in the public interest to reopen the inquests as by now there had been close
examination of the causes of the collision and safety had greatly improved
on the Thames. But his decision added to the relatives’ pain: some believed
this was biased thinking, particularly after he made some unguarded
comments about one of them to the press, which were subsequently
published. The relatives not only wanted a full inquest, they wanted a full
public inquiry. Both requests had been stonewalled and it is to their great
credit that their determination did not falter. They intended to pursue the
possibility of an inquest through the Court of Appeal.
However, their anger was fuelled by their recent discovery – and
unfortunately many of them made this discovery through the Sunday
newspapers – that hands had been removed from some bodies in order to
identify them. Even more upsetting than that, it had now been learned that
the hands were sent back to the mortuary but, unforgivably, some were
never actually returned to their bodies. And relatives suspected that the only
reason they had been denied access to their loved ones before their funerals
was not because the bodies were too decomposed for viewing but because
they lacked hands.
Everyone now directed their anger at the pathologist in charge. That
pathologist was me. In their position I, too, would have been angry. But it
was wretched to become the focus of such fury. It was no use saying to
heartbroken, bereaved people that hand removal was routine in these
circumstances. It was no use explaining that fingerprinting the decomposing
drowned invariably requires laboratory technology which cannot be carried
out at the mortuary. And it was too late to ask whether, just because this
removal was standard at the time, it really was an acceptable routine.
In fact, neither the decision to cut off the hands of some victims, nor their
actual removal, nor the failure to replace them was anything to do with me.
However, my denials were ignored and my protests taken as somehow
incriminating. My photo (looking rather seedy, tie always flying behind me
in a sinister fashion) kept appearing alongside newspaper articles,
accusatory or snide in tone. I received phone calls from journalists at all
hours of the day and night. I was frequently doorstepped. One hack
appeared, as though by magic, in the office. I found him sitting by my desk
with solemn face and an ominously open notebook.
As for my colleagues, their headshaking over my contribution to the
Rachel Nickell case continued into my handling of the Marchioness case.
They asked, couldn’t I have stopped the hands from being removed?
Especially as, in most cases, other forms of identity were rapidly available.
After all, hadn’t the police reported that they were being swamped with
dental records from across the globe? So surely I should have intervened in
the idiocy of the hand removal.
My colleagues did agree, however, that they were all speaking without
any experience of a mass disaster, and certainly not one due to drowning.
And they agreed they were speaking with the advantage of hindsight,
admitting they themselves probably would not actually have intervened in
what was police standard practice at the time – especially since it had been
authorized by the coroner.
Iain, head of department, maintained a sphynx-like silence on the whole
matter, as he did on any important cases which he was upset at missing. I
felt entirely alone with the fury of the press and the Marchioness relatives, a
difficult position, no matter how much I sympathized with that fury.
Pam, who might have offered me some support, was no longer our chief
organizer. Quite late in life she had fallen in love with a widower and
stepped into the role of wife and stepmother. She didn’t even try to mix
pathology with home-making. She recognized that the demands of running
a family did not allow space for the complexities of the pathologist–
homicide interface. We had bidden her a sad farewell, the other assistants
then all reshuffled, a new junior appeared for us to introduce to our murky
world of London murders and the capable Lorraine was put in charge.
Oh, and there was a new pathologist.
One day a tall, blonde, leggy woman had strolled into the office. She
wore a short skirt and a friendly smile and had cheekbones which looked as
if they had been cut out of stiff white paper with sharp scissors. The other
staff barely had time to look up from their desks before Iain, as the most
alpha in an office of alpha males, shot out of his seat and claimed her, yes,
like a Neanderthal, because in the last century the male sex was a great deal
less evolved.
Vesna Djurovic was a forensic pathologist, half Serb, half Croatian, from
what was then Yugoslavia. She was the, in those days, unusual combination
of breathtakingly glamorous and highly skilled. She had been practising in
Belgrade and was now looking for a job in London. She not only found a
job at Guy’s but also something she had perhaps not expected: a husband.
Iain was already married and the resulting manoeuvres were complex and
difficult, but, in so far as our dark landscape of homicide could shine with a
celebrity couple, Vesna and Iain were soon it.
Jen and I could never be such a couple. With Vesna and Iain in forensic
pathology together there became more social events involving partners but
we were too busy to join in most of them. Jen had just finished her house
officer year. Her shifts were thirty-six hours, which meant long days and
alternate nights in the hospital. However, this pattern was just beginning to
ease now because she had started to train as a GP, at the same time finding
what was to become her particular interest: dermatology.
I knew that, at this stage of her career, she needed a lot of support. I’d
needed it too, and she’d been there for me. Now I was trying to do the same
for her. Becoming a doctor was such an achievement when she hadn’t even
started studying until she was over thirty. Probably I didn’t express my
pride often enough. I hope I expressed it sometimes. I mean, at least once,
for heaven’s sake.
Now our paths seldom crossed, and when they did we often argued.
There didn’t seem to be a mechanism to help us find our way back to a
safer, happier place. I knew some couples reconciled in a loving, kind way,
but I had never seen it happen – certainly that kindness had been lacking in
my father’s relationship with my stepmother – and I wouldn’t, or perhaps
couldn’t, play the game. How exasperated my good wife grew with her
busy, distracted husband.
‘Why won’t you let me love you?’ Jen would cry. ‘Why are you so quiet
all the time?’
We went for counselling. I agreed to it, but all the same I felt as if Jen
was hauling me up before the beak.
‘His mother died when he was nine,’ she said significantly. And the
counsellor nodded, also significantly it seemed to me. Were they old
friends, these two women, or was all womankind in some kind of
conspiracy?
‘What would you like Dick to do for you, Jen?’ the counsellor said.
‘Just put his arms around me and tell me he loves me! That’s not much to
ask, is it?’
‘And Dick? What would you like Jen to do for you?’
I thought. But not for long.
‘Make me supper,’ I said.
The counsellor leaned back in her chair, eyebrows raised.
Jen’s lack of culinary skills had always been a bit of a joke.
‘Preparing and giving me a meal. That would be an act of love. But I’m
always too busy looking after everyone to receive and Jen’s always too
busy with her training to give.’
‘So, Dick, you feel you look after everyone?’
‘I’m not complaining. My father did it too, he brought me up. I’m
pleased to care for the kids and cook and be there for them, that feels
normal. It’s just …’
My father had done all those things. But there had been his anger too.
The way it occasionally just exploded out of him, whatever the collateral
damage to those around. Now I began to wonder if that had in fact been the
welling up of some great unhappiness. My father had been unhappy. Maybe
I, too, was unhappy. It occurred to me for the first time that my marriage
might be improved if, like him, I sometimes lost control and allowed my
feelings to erupt. But, if I had any such feelings, they were firmly buried in
some inaccessible place. And if I couldn’t even cry, how could I erupt?
‘Yes?’ said the counsellor. I had forgotten that I was sitting in this room
now in Clapham with ambulance sirens blaring outside and my wife and a
counsellor watching me, waiting for me to speak.
She prompted, ‘You do the cooking and a lot of childcare but it’s just …
what?’
‘I’d like Jen to show me she loves me by doing things sometimes.’
The counselling didn’t last long. Somehow it fizzled out, or maybe we
were too busy. Our children were still primary-school age, they were happy
and healthy and we worked hard to create a loving home. There was often
noise, sometimes music, sometimes laughter. Jen and I were both fully
involved in jobs we loved. We were comfortably off. I had joined the
parents’ choir at the kids’ school and by now I had become a loud,
shameless and, I fear, usually tuneless singer. Jen, Chris, Anna and I all
sang our way up the motorway to holidays full of sand, rock pools,
mountains and moors on the Isle of Man, where we were received by
generous and cherishing hosts. Our lives were surely good enough.
24
My fortieth birthday coincided so closely with my father’s death that it was
inevitable I would start to contemplate my own demise. I did not fear death,
but did not much like its predecessor, senescence, the preprogrammed
process of ageing. By now I had seen so many bodies that I was all too
familiar with the progress of senescence and had a good idea what some of
my own vital organs must look like.
At forty, I knew that, on my lungs’ smooth surfaces, tiny black dots were
already forming into lines, making tree-like patterns. In their own way the
patterns might be rather beautiful, but this was filth: the sooty pollution of
London, which alone had probably ensured that I already had a degree of
emphysema – even without the twenty or more cigarettes I smoked each
day. I wasn’t the only smoker, of course. My colleagues smoked, and we
worked in a perpetual blue haze. At home, Jen smoked. On the Isle of Man,
her parents smoked. Everywhere, our friends smoked. In 1992 we all
smoked, we smoked in pubs and restaurants, we smoked on trains, at our
desks and on the bus. We knew it was bad for us, we knew that cigarettes
contained over 4,000 constituents, many of which are toxic, from hydrogen
cyanide to cadmium to benzopyrene, but we put up with all that for just one
ingredient: nicotine. So far, we’d been young enough to think we were
invincible. Now I knew that I must stop smoking, and I might be rewarded
with an extra ten years of life. Although the structure of my lungs must
have been irreparably damaged, and inevitably that damage would increase
over time.
Pumping blood through damaged lungs is hard work for the heart, and I
hoped that the right side of my heart was not already enlarged by struggling
with this extra burden. As for its left side, I knew that, if I couldn’t learn to
control my reaction to stress, then my blood pressure would rise and my left
ventricle would thicken trying to cope. The heart is an organ one can hold
neatly in the palm of one’s hand. So small but so steady, a little fist,
clenching and unclenching seventy times a minute, day and night, year after
year, 30 billion times over a lifespan. A faithful friend. Until it stops. It was
down to me to repay its fidelity by managing my diet, exercise, smoking
and stress levels. Just as I knew I should give my liver a rest sometimes
from alcohol if I wanted it to carry out its magical repair work on itself.
Good resolutions, all of them. And quickly forgotten. An occasional
whisky and soda seemed a good way of relaxing and it was much easier to
light another cigarette than waste time contemplating how much I wanted
one but couldn’t have one. Stress-relievers, both. And I see in retrospect
that there was no question of my giving up that year or the next, because
1993 heralded a period of very significant cases.
In April I performed a routine post-mortem on a young black man from
south London who had been stabbed. There were a lot of such knifings then
and this death looked like many others. They often turned out to be gang or
drugs related. Racial attacks at that time were not immediately suspected.
The only information I was given was that the young man had been in a
fight. There was nothing to indicate to a pathologist that this was an unusual
case, nor that the patient’s name would become so well known, nor that I
would have to give evidence about his death so many times.
Stephen Lawrence was a bright, ambitious eighteen-year-old who in no
way fitted wider public perceptions of black youth in 1993. Rightly or
wrongly, his recognition as a keen student who had a professional future
was vital to changing attitudes and prejudices. While simply waiting with a
friend for a bus he was stabbed twice by a group of white youths, who, we
later learned, were hurling racist comments. There was a superficial
incision on his chin, one deep stab wound that had penetrated his lung and
another deep wound on the shoulder. Bleeding profusely, he somehow
managed to get up and run over a hundred metres with his friend before
finally collapsing.
In the months that followed I was shown by the police a total of sixteen
knives, of which seven were possible murder weapons. One of these looked
particularly likely. In July I was asked to make a further statement and said
that, in my opinion, Stephen had been standing when he was stabbed
around the right collar bone but had probably begun to fall by the time the
second stab wound was inflicted on his left shoulder. Despite some very
careful thought, I wasn’t able to say with full confidence whether his
assailant was right- or left-handed. Choosing one over the other might have
made me look clever but the evidence was really too flimsy to risk
exonerating the perpetrator.
That was the extent of my involvement with the police’s investigation
into Stephen’s death at that time. I was unaware of the indifference and
racism that were hampering it. The Lawrence family, however, were not.
They understood there were witnesses, evidence and indeed suspects. But
no charges were made.
Four months later, I was called to observe a coronial post-mortem in
north London on behalf of the police. The post-mortem was actually
performed by another pathologist: it was my job to watch, take any relevant
samples and possibly participate if invited to do so but, on the other
pathologist’s insistence, I just watched. It was fairly clear to me that the
woman we were examining had died of the adverse cerebral consequences
of asphyxiation but there might be other causes of death revealed by the
experts who were invited to give their specialist opinions on some of the
organs – specifically the brain and the heart.
The deceased had obviously been involved in a fierce struggle and then
manhandled into a body belt – that abdominal belt with the handcuffs
attached. She was covered in cuts and bruises and had been bound at the
thighs and ankles as well as the waist. Had she, in fact, sustained a head
injury also? The brain pathologist would answer that question for me.
This case also turned into a significant one. Joy Gardner was a fortyyear-old Jamaican who lived with her five-year-old son. That she had
outstayed her visa and was in the UK illegally is not in dispute. Her mother
and a large number of relatives were here, offering support while she
studied, and she did not want to return to Jamaica.
Early one morning and without warning, immigration officers arrived at
her home to deport her. They were supported by police officers, perhaps
because resistance was expected. And Joy Gardner did resist. She must
have thought she was fighting them for her way of life. She perhaps did not
guess that she was fighting for her life.
Unskilled, untrained and determined to carry out orders, the officers
struggled to get her into a restraining belt while she fought them and bit
them, watched by her young son. In response to her biting, they wound
almost four metres of one-inch-wide adhesive surgical tape – Elastoplast –
around her mouth and face. They mistakenly believed that by leaving her
nose clear they were allowing her to breathe. This is a myth. Covering the
mouth can kill. It is not just a question of being able to breathe – it’s a
question of being able to breathe enough. Especially if a struggle has caused
stress and exertion and massively increased the body’s need for oxygen. In
these circumstances, an individual simply cannot take in the oxygen
needed, which may be many times more than usual.
Gagging can cause vomiting and, with the mouth blocked, vomit
obviously cannot escape. So it gets into the airways. And a gag can press
against the tongue, pushing it to the back of the mouth and blocking the
back of the nose. Secretions also accumulate in the mouth and throat, and
this further inhibits the ability to get air into the lungs. Gagging a distressed
woman who had been struggling hard for many minutes was all it took to
bring about cardiac arrest.
Joy Gardner was not strangled. There was no traumatic head injury. She
had not inhaled her own vomit. She was asphyxiated by the gag. However,
an ambulance crew managed to resuscitate her. That is, they restarted her
heart and then rushed her to hospital where she was placed on life support.
Sadly, her brain had been so badly damaged by the prolonged lack of
oxygen that she died four days later.
There was a breadth of involvement in this case – hospital, police, family
– and consequently her body underwent so many post-mortems and so
much tissue analysis that meetings about Joy Gardner sometimes felt like
pathology conventions. Among the most important were the brain
specialists, since it had been alleged by the first pathologist, whose postmortem I had watched, that she had died from a head injury. Finally,
overall, there was broad, general agreement that she had died from asphyxia
caused by the gag.
I wrote a detailed report examining all the possible causes of death,
which, as usual, went through various drafts and revisions. In the meantime,
there was a growing outcry from human-rights organizations and others. It
seemed to many, especially members of the black community, that police
officers who regarded deportation as a job to be done at any cost and that
they had killed Joy Gardner by thoughtlessly over-restraining her.
You might remember that the first death in custody I encountered caused
by restraint had left me feeling some discomfort at the coroner’s verdict.
That patient had both pneumonia and sickle-cell trait and so was deemed to
have died of natural causes aggravated by lack of care. From that day, I had
been concerned about the methods sometimes used by enforcers of the law:
it was obvious that some simply didn’t know how to restrain people safely.
And restraint – indeed, death from restraint – was definitely on the
increase. Joy Gardner was restrained so that she could be deported. Other
deaths were caused when the police tried to apprehend suspects, particularly
if those suspects had sickle-cell trait. But most deaths we were seeing
caused by restraint now were due to another factor: the spiralling use of just
one drug. That drug was, of course, cocaine.
Cocaine blocks the brain’s uptake of neural transmitters and the blockage
can give continual, pleasurable stimulation: it gives confidence, euphoria
and energy. Cocaine users can talk for hours, have heightened responses to
physical stimuli, so sex is more enjoyable, and they have little need for food
or drink. It can, however, lead to a greatly stimulated heart rate, agitation
and psychosis. So, if restraint is required for a cocaine user, it is usually
because he appears to be suffering from uncontrolled psychosis.
My first cocaine death came at about this time, and it was an early
marker in Britain’s rising cocaine use. A very large and muscular drug
dealer (who was also himself an addict) was arrested, having just bought a
large quantity of cocaine, and at once began to punch the two police officers
detaining him. An officer stuck an arm around his neck but that was just
one manoeuvre in what was pretty much a fight. The fight ended with the
dealer’s death. But how had he actually died?
A highly regarded neuropathologist confirmed that the dealer did not
sustain a head injury in the fight, so that was not a cause of death. He may
have been asphyxiated by the arm around his neck, but he showed only one
of the three classic signs of this: insufficient to give asphyxiation as a cause
of death. He had consumed a lot of cocaine, but his blood sample put him
below the fatal level, so he probably did not die of an overdose.
Finally, I gave a combination of causes: the stress on his heart generated
by his fight with the police, coupled with the fundamental stress caused by
his cocaine use. Although a young man, he suffered from an inflammation
of the heart muscle. Now this is recognized in cocaine users and sometimes
called ‘cocaine myocarditis’.
Charges against the two police officers were later dropped. But this was
another case that left me with a sense of discomfort I could not ignore.
There were simply too many deaths when police officers restrained people.
They surely believed that they were simply doing their duty, and they
certainly had no intention of killing anyone. But people were dying. I knew
I would have to do something, but it wasn’t clear to me yet what I could do.
While we waited to see if anyone would be arrested for Joy Gardner’s
death, headlines everywhere announced an arrest for Rachel Nickell’s
murder. It came as no surprise to me. I had been aware of the police’s
suspicions about a man called Colin Stagg. I knew that, in the absence of
forensic evidence, they had set up a honey trap on the advice of a
psychological profiler. They recorded intimate sexual conversations
between Stagg and an undercover policewoman, hoping Stagg would reveal
himself as Nickell’s murderer. He did not, but the Crown Prosecution
Service thought that what he did say was incriminating enough. I answered
a number of questions about the murder from the team targeting Colin
Stagg and my reconstruction of events that day on Wimbledon Common
was used as evidence for the prosecution. I was expected to appear as a
witness at the trial the following year.
With Britain’s most notorious murderer now believed to be safely on
remand and awaiting trial, I was surprised to be called, in the autumn, to the
body of another young woman. She had been the victim of an even more
deranged attack than that on Rachel Nickell.
Jack the Ripper, who killed at least five women in East London in 1888,
is still the stuff of film, fable and countless guided walks daily around
Whitechapel. I suspect that the public is so fascinated by his gruesome
crimes because they happened long ago. Samantha Bisset’s name, and that
of her killer, are barely known, I believe because she was the victim of such
a truly shocking Ripper-type murder that the press, for once, was reluctant
to inflict on readers the horrific information unfiltered by time’s lens. I feel
the same reluctance and do not here give details of this homicide.
Not only was Samantha killed and sexually assaulted, but also her fouryear-old daughter. Whose body was then tucked into bed with her toys so
that the first police officers on the scene harboured hopes, soon dashed, that
she had safely slept through the murder of her mother.
I was called in by the coroner, my interest in knife crime now widely
acknowledged, to carry out the second post-mortem on the bodies of
Samantha Bisset and her daughter. This second post-mortem was not for the
defence, since no one had been charged with the murder, but for the coroner
so that the bodies could be released.
It had fallen to a colleague to visit Samantha Bisset’s flat, where these
crimes had taken place. Therefore I saw the scene only through the
photographer’s lens. I could imagine the terrible silence, how the usual
camaraderie, the exchange of pleasantries, inquiries about families or
holidays, the workaday stuff we use to remind ourselves of normal life
when we are confronted by a homicide, how even that must have been
impossible for all investigators in the home where these acts of cruelty and
mutilation had occurred.
As I carried out the post-mortem, it became clear to me that the killer had
been, like Jack the Ripper, something of a trophy-hunter.
I said to the police officers attending, ‘If I didn’t already know you’ve
got Colin Stagg, I could really think this was carried out by the same bloke
as Nickell’s murder.’
The senior officer shrugged.
‘No way; we’ve got Stagg and he’s as good as confessed.’
‘It’s not that similar,’ pointed out his colleague. ‘No one mutilated
Rachel Nickell.’
‘Maybe he would have done if he hadn’t run out of time. Maybe he
wanted to enjoy himself killing her but he was in a public place and he just
couldn’t do that without getting caught. Killing a woman slowly in her own
home probably would have been the next step for him, too.’
‘Yeah, well, he’s inside and he’s staying there for the rest of his life,’ said
the officer. And soon the same could be said of the man who killed
Samantha Bisset. Robert Napper was a twenty-eight-year-old
warehouseman with a history of violence and mental illness. He had often
been brought to police attention but somehow, perhaps due to poor recordkeeping in those days before the widespread use of computers, he had
always slipped under the radar. Now his fingerprints in Samantha Bisset’s
flat connected him to this crime.
On his arrest, the police were confident that they had taken two ruthless
murderers, Stagg and Napper, off the streets. So it was a very great shock
when, in September 1994, Colin Stagg was acquitted.
The case was thrown out by a judge who said that the police operation
was nothing more than entrapment and that, because Stagg had been lured
into talking to the undercover policewoman, anything he said was
inadmissible evidence. I was as astonished as everyone else: the police had
worked with many professionals on the case and it had not occurred to me
to challenge their absolute certainty that Colin Stagg had killed Rachel
Nickell.
Colin Stagg was released – but into a different sort of jail. He only had to
walk outside his front door to be subjected to immense cruelty. The police,
press and, most of all, the public, were still convinced that Stagg had
murdered Rachel Nickell and somehow got off on a legal technicality. This
belief was so widespread that it didn’t even occur to me to draw attention
once again to the similarity between Nickell’s killer and Bisset’s. I had
learned only too well that expert opinion is marginalized by the system and,
despite my brief foray into crime reconstruction, I was now firmly back in
my box.
25
The relatives of those who died when the Marchioness went down had
doggedly been pursuing their case all these years. Now they won a victory.
When their attempts to persuade the coroner to reopen an inquest had got
nowhere, they had turned to the Court of Appeal, which agreed that, by
refusing them an inquest, the coroner was ‘in real danger’ of showing
unfair, though unconscious, bias. As a result, an inquest was finally held by
another coroner. Six years after the disaster, in 1995, the inquest jury agreed
nine to one that the victims were ‘unlawfully killed’.
There was no one to prosecute now, since two attempted prosecutions of
the Bowbelle’s master had failed, but the verdict fuelled the relatives’ belief
that there should be a public inquiry. An action group continued to push for
one. Their efforts were resisted by the authorities because there had been a
complete overhaul of river safety as a result of the accident and it was
argued that there would be nothing now to be gained by a public inquiry.
The action group did not agree. Although it must have taken a great
personal toll on them to continue their fight, the relatives insisted there was
more to learn from their suffering and that a public inquiry was the best
forum.
No one ever forgot the missing hands of the victims, and I was still held
responsible for this. So, while I agreed with the reason the relatives wanted
an inquiry, I dreaded it. Because the whole subject, including those hands,
would surface yet again.
Pressure from the ground up on intransigent authorities was also evident
in other important cases at that time. The investigations into the deaths of
Joy Gardner and Stephen Lawrence, two years on, just seemed to be
fizzling out. Except that there were many people who were not going to let
that happen. First relatives, then whole communities, set out to mobilize
public opinion by showing that, in the case of Stephen Lawrence, racism in
the Metropolitan Police was hindering the investigation. In the case of Joy
Gardner, they had to show that someone other than a court had decided to
exonerate the officers involved.
At first, not much changed in the Lawrence investigation. However, to
the astonishment of the Met, who insisted their staff had only been doing
their job, prosecutors now charged three officers with the manslaughter of
Joy Gardner.
At that trial, the QC gave me a cross-examination I shall never forget.
Someone had leaked a copy of an early draft of my report on the case, and
he pointed out that in my final draft there were over seventy changes. He
dragged me through them, one by one, asking me to justify every word
change, deleted comma or additional semi-colon. I felt my minor revisions
(for instance, changing probably to possibly, or quickly to rapidly) made
little difference to the overall case, but it was useless to say that in each
draft I was refining and clarifying. The QC’s clear implication was that I
worked closely with the police and had been leaned on to make them appear
less culpable for Gardner’s death.
Our exchanges went something like this (and I am writing from memory
since no transcript seems to have survived):
QC: Let us look at here … why did you revise the word ‘severe’ to ‘moderate’, Dr
Shepherd? For that was certainly a dramatic revision.
ME: It seemed on reflection a more appropriate description.
QC: But why was it more appropriate?
ME: Well, I considered all the facts again very carefully and revised my opinion.
QC: Are you sure that revision wasn’t based on the receipt of further information?
ME: It was based entirely on my analysis of the case.
QC: But why would you make so extreme a change if you had no new information?
ME: I felt it was more correct.
QC: So … are you saying you … changed your mind?
ME: Indeed, I changed my mind.
QC: You simply changed your mind! Changed it on a, on a, on a mere whim?
I can see why he was suspicious. Of course, I regularly worked with
police officers and it might have seemed a fair assumption that I was trying
to please them. In fact, no one had leaned on me. Nor do I try to please.
Yes, it might have felt awkward working with the Met if I had been
instrumental in convicting three of its officers, that is the sort of dilemma I
had always known a forensic pathologist must face occasionally. I had
hoped that I would respond bravely to pressure and treat truth as my
greatest ally.
Scandalously to many, all three officers were acquitted.
Personally, although I could not condone their actions, it was clear to me
that the officers were, themselves, victims in a way: victims of an entirely
flawed system. They had not been trained or informed how to restrain
safely, they had not been warned about the possibly dangerous effects of
their actions. They did not know the rights or wrongs of Joy Gardner’s
deportation. It was their duty physically to carry out the orders of
bureaucrats who made their decisions on behalf of the British people. They
thought that by restraining Joy Gardner they were simply doing the
unpleasant job they were paid for. The fact that they did it so badly, I felt,
reflected on their employer’s bad practice.
Joy Gardner’s sad death was a catalyst for change. For me it was the last
straw. I knew now what I had to do. I became an active and enthusiastic part
of, indeed sometimes the instigator of, bodies set up not just to review
restraint procedures but to train properly anyone whose job requires them to
restrain: principally police, prison and immigration officers.
It is impossible to know what will later be the significance, if anything,
of one’s own life: I’d like to think that in my case it will be my contribution
to this change. It has largely been a question of making a nuisance of
myself, running training courses, organizing conferences, writing reports,
sitting on committees but, most of all, education.
Detractors of the police may be surprised that I found most officers
extremely keen to learn correct and humane restraint: they, more than
anyone, were aware of the deficiencies in their practice. They, more than
anyone, knew that it wasn’t just the families and friends of the victims who
suffered, it was also officers’ lives and careers which could be completely
changed by the events of a few minutes. However, it was many years before
every single organization which can lawfully restrain, from the Border
Agency to the Youth Justice Board, finally endorsed the set of principles for
safer restraint that we succeeded in introducing to Metropolitan Police
training after the Joy Gardner case.
I became a member of the Independent Advisory Panel to the Ministerial
Board on Deaths in Custody. It is jointly sponsored by the Departments of
Health and Justice, as well as the Home Office. Sounds bogged down in
bureaucracy? It isn’t. That’s just how much elbow power we needed to
ensure the set of guidelines I wrote would be approved and adhered to.
The guidelines recognize that restraint can have a significant
psychological effect on everyone involved, including those who witness it.
They set out the principle that restraint should be used only when it is
necessary, justifiable and proportionate to the perceived threat. And they
acknowledge the possibility that poorly applied restraint can lead to death.
So only approved techniques should be used, and only by trained,
authorized staff.
Once an incident is underway, management is essential. I like to think
that the guidelines here were influenced by my flying experience. Where
there are two pilots in a plane, only one is in full control and, when control
is passed from one to another, both pilots must verbally acknowledge this.
PILOT 1: I have control.
PILOT 2: You have control.
This routine brings clarity in a crisis. So I had the idea of transferring
aviation practice to the crisis which is a restraint situation. In this crisis, the
person who is responsible for the detainee’s head, neck and breathing is the
person in control. It doesn’t matter if it’s the lowest-ranking officer present,
that person must take control by saying, ‘I now have control of this
incident.’ The others must acknowledge with, ‘You now have control of this
incident.’ Crucially, control gives the authority to order an immediate
release and be obeyed.
There is more detail of course, involving medical monitoring, filming,
records and debriefing. But the overall aim was to turn the rugby scrum of
forcible detention into something used only when necessary, and in a wellmanaged and safe way. The result, I believe, has been a dramatic reduction
in the number of restraint deaths by the authorities. In fact, it is now much
more dangerous to be arrested by a fellow citizen or shop or nightclub
security staff.
After the acquittal of the officers in the Joy Gardner case, there were calls
for a public inquiry. Which were resolutely resisted. As for the Stephen
Lawrence case, it was clear the police investigating knew some names and
had suspicions. However, no prosecution followed and so Stephen’s parents
and friends began a heroic and dignified struggle for justice. They pressed
ahead with their own civil prosecution of three of the five alleged killers.
I was called as a witness at this trial. Michael Mansfield QC was acting
for the family in the unaccustomed position of private prosecutor. But it was
all to no avail. The world watched as the proceedings collapsed almost
before they started for lack of evidence considered admissible by the judge.
Worse, the double jeopardy law at that time meant that the three who were
tried could never again be tried for the same crime and it seemed that all
possibility of justice was lost for the Lawrence family.
However, they did not accept this. They now demanded an inquest. It
seemed public opinion was fully behind them. Many had been shocked by
the acquittal of the officers involved in the Joy Gardner case. Now people
were beginning to believe that the investigation into Stephen’s case was
hampered by the same sort of racism that had led to his death, and even a
public inquiry – established only at the behest of a government minister and
something considerably larger in scale and much more legally powerful
than a coroner’s inquest – began to look like a real possibility.
The Lawrence family’s patience and persistence finally did lead to an
inquest. The five suspects were ordered to appear. They did so, but refused,
as was their legal right at an inquest, to answer any questions. The coroner,
who is not legally allowed to actually name murderers, was helpless in the
face of their rude silence. However, the jury found a way around that and
cleverly concluded, in February 1997, that Stephen Lawrence had been
‘unlawfully killed in a completely unprovoked racist attack by five white
youths’. They might as well have said ‘… by the five white youths sitting
over there’. And the Daily Mail more or less did so, publishing pictures of
the five, naming them, and inviting them to sue if the Mail was wrong.
Public scorn at the failure to apprehend Stephen’s attackers reached such
a pitch that at last it really began to seem that demands for a public inquiry
into the Met’s investigative failures would be met. I was personally
delighted by this strong move for change which was now forcing a rethink
in official and police culture. It had not escaped my notice that so many of
the deaths in custody or under restraint I had been dealing with were the
deaths of black people, and, put simply, the potentially increased
vulnerability of some individuals through sickle-cell trait certainly did not
explain this disparity. I could see change was necessary, but I could not
imagine how change might come about. It never occurred to me when I
examined the body of Stephen Lawrence that precisely those knife wounds
would, over the next twenty years, be the precipitating factor in that change.
26
After about eight years at Guy’s, I had itchy feet. The wing of Iain West had
become more smothering than sheltering and, despite our friendship and his
many promises to promote me, he had not done so. I applied directly to the
medical school dean behind his back for a senior lectureship and was
immediately promoted. But Iain really didn’t want me or perhaps anyone
else to become his deputy. As for his possible early retirement to embrace
fully his country-squire lifestyle of huntin’, shootin’ and fishin’, well, Iain
made it clear that was not even on a distant horizon.
I looked quietly for other openings and continued with my work. By now,
approaching the mid-1990s, both my children were at secondary school and
occasionally I could glimpse in their young faces the adults they would
become rather than the small children they had once been. It had always
been hard to carry out post-mortems on children who were the same age as
my own kids: this was probably the one time my hand wavered –
momentarily – over a body. And now that they were growing up, there
seemed to be more cases involving children. Had I been avoiding them
before? Or were they really on the rise?
One day I was called to examine a baby who had died in his mother’s
arms at ten months. I found him to be well nourished and well grown. There
had obviously been resuscitation attempts but there were no other marks on
him, and certainly no sign of violence or trauma. The internal examination
was just as unrevealing: there was not one indication of abnormality.
I waited for the toxicology, virus and bacteria test results but decided that
if they were all clear I would have to give sudden infant death syndrome as
the cause of death. The police were not too happy that I was thinking SIDS
and promptly handed me a bundle of background notes. Ah. Now the case
had a context, and what I read seemed to change things.
Officers had arrived at the mother’s flat in response to her 999 call. She
was twenty-two years old and lived alone after receiving death threats from
the baby’s father. Those threats – but also the mother’s drinking habit – had
placed the ten-month-old baby on the at-risk register. To protect them
against the father, an attack alarm had been installed in the home.
When the mother phoned the emergency services at about 9 p.m. she
sounded drunk and referred to a ‘death in the family’. The attack alarm rang
too, but only as police were actually on their way to the flat.
The police were concerned because, only a month before, this young
mother had been convicted for being drunk in charge of her child. This is an
offence that carries a fine and rarely a custodial sentence: its main purpose
seems to be either to humiliate mothers into sobriety or to alert social
services to the possibility of neglect or abuse.
On arrival, only seven minutes after her call, the police rang the bell. No
one came to the door. They peered through the letterbox and could see the
mother pacing up and down the hallway with the baby in her arms.
She was not panicking and there was no obvious threat, so they did not
break in. They gently persuaded her to open the door, although she had
great trouble doing this because she was so drunk. When eventually the
police were able to enter, they found that the baby she had been cradling
was dead.
All attempts were made at resuscitation. The mother was angry,
aggressive and, of course, upset. A couple of hours later a blood sample
was finally taken, and from this it was possible to extrapolate her blood
alcohol level at the assumed time of the baby’s death: that is, when she
dialled 999. The level was 255mg/100ml of blood. It is illegal to drive
above 80mg in England and Wales (now 50mg in Scotland) and for a less
hardened drinker 255mg/100ml could possibly be a fatal dose. So we can
conclude that, although she was clearly accustomed to alcohol, the mother
was very drunk indeed.
The sample revealed no evidence of any drug use. However, she was too
drunk to explain whether the child had died in her arms or in his cot or on
the sofa or her bed. And she was unable to say where she had been at the
time.
Perhaps your sympathy for the bereaved parent is now strained. Perhaps
mine was. I had the baby’s blood tested for alcohol and drugs. By now we
had begun to recognize that some parents who drink or take drugs, in order
to keep their children quiet while they do so, administer to them the same
substances they enjoy. And sometimes they administer a fatal dose.
However, when the toxicology report came, it revealed that this was not the
cause of the baby’s death.
There are fads in illnesses, as in most things. Their popularity waxes and
wanes according to our perceptions. Sudden infant death syndrome, where
an apparently healthy baby dies for no evident reason, gradually entered the
public consciousness during the 1970s and 1980s and by the early 1990s it
had become statistically significant, peaking at two per thousand live births.
SIDS was a welcome diagnosis for many pathologists. It seemed to
explain the unexplainable and it cleared parents or carers of any blame.
SIDS says that the baby did not die of any unnatural cause and so the
assumption must be that it died of natural causes. But SIDS was not
universally acceptable – there were some police officers and non-medical
coroners who were sceptical.
In this case, the police suspected that the drunken mother’s hand had
been involved in the baby’s death. This was reasonable in the
circumstances, except that there was simply no evidence at all to support it.
Therefore, having excluded all other possible causes of death, I was left
with SIDS. There were many changes in my life immediately after this.
And I was to look back on the cause of death I gave in that case just one
year later and feel some surprise.
This was, in fact, my last case at Guy’s. I had learned of the forthcoming
retirement of Dr Rufus Crompton from my alma mater, St George’s
Hospital in Tooting. He was my former teacher and mentor, who now
headed a department of which he was the sole member of staff. The
opportunity to replace him was really exciting. St George’s was willing to
grow the department and if I got the job I’d be able to expand it along the
managerial lines that I was always suggesting to Iain and which he
completely ignored.
One grey day I asked Lorraine if Iain was free and then walked rather
nervously into his office. It was a large room, filled with utmost chaos.
Stacks of files and other papers teetered on the desk, on every shelf, on the
floor and on the huge table at the centre of the room, which was used for
meetings. When one was scheduled, Lorraine would move all the piles of
paper off the table, finding some corner of the floor for them, and take away
the overflowing ashtrays and the old cigarette packets. When the meeting
was over, it would all start again. Judging from the clutter on its surface, I
estimated that it had probably been over a week since the last meeting.
Iain was sitting at his desk and did not immediately turn his huge jowls
towards me when I came in. This was perhaps not the best time to approach
him, because I knew he was tired. Yesterday he had been shouting, which
always meant that, whoever he appeared to be angry with, he was actually
angry with himself, generally because he had failed to do something.
Although of course he blamed Lorraine: she had not reminded him to
produce that report on time. The report had almost certainly been sucked
into the vortex of other files on his office floor but the court had been
unsympathetic and ordered him to produce it by this morning at the latest.
So he and Lorraine had been in the office until late last night, he dictating,
she abandoning her shorthand pad and typing directly into the computer.
Now he sat with a menthol cigarette between his fingers. Another,
forgotten, burned in the ashtray by his microscope. And a third lay, smoke
spiralling from it, to one side of the room next to the flickering screen of his
huge desktop computer.
I said, ‘Iain, you’ve probably heard that Rufus Crompton is retiring …’
He raised his eyebrows. It had long been understood between Rufus, me
and Iain that one day I might like to go back to St George’s.
‘I’m planning to apply for the vacancy,’ I said.
He lit another cigarette from the end of the one he was finishing, looked
around for an ashtray, or anyway one that wasn’t already full, failed to find
such a thing, and stubbed out the spent cigarette on the packet.
‘I suppose you’ll be needing a reference,’ he said.
He smoked even more furiously than usual but did not betray emotion in
any other way. He was cordial and wished me luck in my application and
we agreed that, if we were both to run departments, we would not be rivals
but highly co-operative with each other. I’m not sure either of us meant it,
though. We were rivals already and now that we were to be equals in
different hospitals that rivalry was unlikely to cease.
Leaving busy Guy’s with its famous departmental head and plethora of
fascinating cases to leap into the unknown was scary. I took a break that
summer from post-mortems as I moved to St George’s and began to set up
the new department. It was essential for the police to recognize us and call
us out, so, tedious though it was, I had to create a sound management and
financial structure.
After a few months of this, I was surprised to find myself missing the
mortuary, where I could use the skills I’d honed over so many years. When
a pathologist friend on the south coast went on holiday I agreed to fill in for
his routine coronial post-mortems. It was the school summer holidays.
Anna and Chris were teenagers now. Anna was still at school but Chris had
just finished his GCSEs and was hanging around at home, so I offered to
take him with me. If he waited while I did a few quick routine postmortems for the coroner – no homicides here, just sudden, natural deaths
which required an explanation – then afterwards we could go for a walk
along the clifftops. Chris was a relaxed sort of boy who was up for
anything, so he was happy to sit reading in the car while I went into the
mortuary to work.
I put on my kit. The mortuary staff had lined the bodies up on tables and
prepared them for me: in those days that meant the bodies were still opened
up, with the ribcages removed, and skulls opened too.
There was the usual small talk with the coroner’s officer, during which I
happened to mention that my son was waiting for me, reading in the car.
The coroner’s officer clearly saw this as borderline neglect.
‘I’ll bring him to the office, he’ll be more comfortable in there,’ he
offered. ‘He can have a cup of tea.’
I was busy over an open body, PM40 in hand, when in the corner of my
eye I saw Chris. He was walking through the post-mortem room with the
coroner’s officer. He seemed unperturbed. I, however, was extremely
perturbed. I wanted to shout, ‘Get him out of here!’
But I knew that would make the mortuary seem even more shocking for
an unprepared teenager so, with a supreme effort of will, I winked at him
from behind my mask and waved my PM40 jauntily. To tell the truth, I felt
unmasked. All these years I had shielded my children from the reality of my
work, without actually lying to them or misleading them, and now Chris
had been unexpectedly exposed to it.
As we walked along the clifftops afterwards, there was a sort of
mumbling between father and son.
‘Er … were you all right with what you saw at the mortuary?’
‘Didn’t really bother me,’ he said. ‘But the coroner’s officer was an
idiot.’
Whatever subject they’d differed over (football, I think), it was more
memorable for Chris than the sights and sounds of a working post-mortem
room. He and Anna had sometimes actually come to the mortuary with me
when I was working, so they were familiar with the smells and the clangs
and the general ethos of the place. If the bereavement room was empty they
would sprawl over the chairs doing their homework beneath the fish tank
while beaming staff plied them with tea and biscuits. They had never
actually asked what I was doing there, out of sight.
I did hope, without voicing this, that Chris wouldn’t breathe a word at
home about his expedition through the post-mortem room. And so, of
course, he told Anna.
‘Can I come to a post-mortem?’ she demanded. ‘It’s not fair if Chris has
been and I haven’t.’
‘I wouldn’t exactly call that coming to a post-mortem …’ I said.
And by now Jen had overheard.
‘You saw what?’ she asked Chris, throwing me an accusatory look.
‘I’ll have to get used to that sort of thing if I’m going to be a vet,’ said
Chris bravely. ‘I’ll have to cut up dead things all the time.’
‘Well, I’m going to be a vet too,’ said Anna. ‘Or a doctor.’
Ours was a medical household and incidents and cases were routinely
discussed, often quite candidly, although I still hid the case photos. If asked
what their parents did, the children still answered, ‘They’re doctors.’ If
pushed, they would say, ‘Dad cuts up dead bodies’ – which usually
prevented any further questions. But, on the whole, it was much easier to
explain that their mother was a GP who was specializing in dermatology
than that their father was a forensic pathologist.
In a few years, Chris and Anna would both be off to university. It was
hard to imagine them as independent people leading independent lives. It
was hard to imagine they wouldn’t need me any more. I determined that,
although my new job would certainly be demanding, I should try to spend
as much time with them as possible before they left.
27
Once I had started up the department I was back in the mortuary, and this
became a busy, productive period. Other staff arrived. Rob Chapman, a
friend and excellent pathologist from Guy’s joined me, and two secretaries,
Rhiannon Layne and Kathy Paylor. And so did two clinical forensic
doctors, Debbie Rogers and Margaret Stark. They examined the living
victims of crime, and they also looked after the medical needs of the people
who had been arrested and detained in police cells. These were the first
academic clinical forensic posts in the UK, a great asset to our embryonic
department. In addition, we had a trainee pathologist. Very quickly, we
became nationally and internationally recognized, and that meant we were
busy almost at once.
Being boss gave me the chance, to some extent, to choose my cases. One
very difficult area I would have liked to palm off onto my colleagues was
the very area I’d been immersed in with my last case at Guy’s – babies. But
I could see that wasn’t fair. Because now everything was changing in the
pathology of child death, and this reflected society’s changing attitude to
children. I realized that now I probably would have given a different cause
of death for the baby of that drunken mother.
From the early 1990s, the number of SIDS deaths – or deaths diagnosed
as SIDS – significantly declined, and that decline has continued (the most
recent statistics tell us that SIDS now accounts for only 0.27 deaths per
1,000 live births).
The improvement was largely due to the worldwide campaign (called
‘Back to Sleep’ in the UK) which persuaded parents to stop putting their
babies face down in bed, as this had been identified as a major risk factor in
SIDS. Other factors we knew of included adults in the house smoking,
adults sleeping on the sofa or in bed with the baby (which could result in
‘overlaying’ or rolling onto the child), alcohol- or substance-abusing
parents, too much bedding and too high a room temperature. With all this
knowledge, and an education programme for parents, the numbers fell.
Numbers also fell because perceptions of SIDS changed, and
consequently the fundamentals of its diagnosis. It was now sometimes
referred to as a ‘diagnostic dustbin’ and guidelines for pathologists were
tightened up. The thinking was that, before diagnosing SIDS, we should
examine very carefully first the history – both the child’s medical history
and the caregiver’s story of events – then the scene itself and finally the
pathology of the deceased child. There isn’t really any positive pathology
for SIDS. It’s a question of confirming the absence of every other possible
cause of death.
And why, really, were guidelines tightening up and people talking about
SIDS as a ‘diagnostic dustbin’? Simply because many pathologists did not
follow the criteria laid down for its use and gave it for any death they
couldn’t explain – and often these deaths were under-investigated by both
the police and the pathologist. SIDS had become such a catch-all that there
were now unpalatable suspicions. Could it be that some so-called SIDS
cases might be acts of adults rather than God?
Those uncomfortable suspicions were rooted in the pioneering childprotection work of Professor David Southall and his colleagues. In the light
of evidence he produced, it was hard not to face facts. He was involved in
studies which not only identified Munchausen syndrome by proxy – parents
with this mental disorder deliberately make their children ill in order to
receive attention and support – but also produced irrefutable evidence
through covert video surveillance that some parents certainly do attempt to
injure or even kill their children for reasons that are unclear.
In his most famous investigation, thirty-nine children who had recurrent
episodes of apparently life-threatening events, usually outside hospital but
sometimes on a hospital ward, were referred to a specialist ward where they
were secretly filmed. In thirty-three cases, these ‘events’ turned out to be
induced by a parent. The covert footage showed incidents not just of
emotional abuse but also poisoning, strangulation and, especially,
suffocation. In fact, there were no fewer than thirty attempts at suffocation
in just this small group.
Thanks to the surveillance, professional intervention protected the
children. But between them those children had forty-one siblings, of whom
twelve had died suddenly and unexpectedly. Once the parents were
exposed, four actually admitted to killing eight of these siblings. When
these ‘sibling’ cases were reviewed it was found that, in eleven of the
twelve cases, the cause of death given by the pathologist who had
performed the post-mortem was SIDS. In the twelfth case, the cause given
had been gastroenteritis, but further investigation now revealed the child
had been poisoned. Fifteen more of the forty-one siblings were later
discovered to have suffered abuse.
Naturally, there was widespread shock at these findings and considerable
disbelief. I feel, as a result of David Southall’s work, we started to move out
of an age of innocence. A lot of people, however, preferred innocence. It
was hard to accept that there were children who needed protection from the
very adults who should be protecting them.
Suspicion gradually became an almost routine response to the
unexplained death of a baby, and that must have felt very unfair to the
innocent. So unfair that David Southall faced vitriolic and vocal opposition.
The ethics of his covert video surveillance of parents came in for particular
criticism. I fear that, without it, he never would have been believed, so
incredible did his results seem at that time.
Parents (as well as many police officers and even social workers) who
had once regarded any concern from outside the family for the welfare of
children as an invasion of privacy, were now forced to accept change. Adult
victims of all sorts of parental abuse were talking publicly about their
childhoods and a light was shining onto family secrets in a way that had
been impossible when privacy was king. That light was held by
professionals working with children – health visitors, doctors, nursery staff
– who were now encouraged to report any suspicions of abuse.
As child protection became a subject for national debate, the discussion
about unexplained baby deaths left theory behind and became concentrated
in the specifics of just one case. I am talking about the trial of Sally Clark.
SIDS had once taken a cruel harvest from right across the social
spectrum, but as the middle classes became informed about risk factors and
minimized them, SIDS began to look like something more likely to affect
the poor. Until, in 1996, Sally Clark, a well-off, middle-class solicitor and
policeman’s daughter whose background and bearing reflected that of so
many respectable, professional, working mothers, lost first one baby to
SIDS. And then, in 1997, another.
The first baby, a boy, was eleven weeks old. Sally Clark’s husband,
Stephen, also a lawyer, was out at the office party when his wife found the
baby unconscious. She called an ambulance, but for some reason she was
unable to open the door when it arrived. The baby the paramedics
discovered had no pulse and had been cyanosed – meaning his lips and
fingers were blue – for some time. But he was only officially declared dead
after an hour when resuscitation attempts failed.
The pathologist who conducted the subsequent post-mortem was worried
by particular injuries: a split and bruise at the top of the baby’s mouth,
inside the lips, and the absence of any obvious cause of death. He had these
injuries photographed and it is very unfortunate that the photographer’s
camera was not working properly and the resulting pictures were of such
poor quality that they were to prove absolutely unhelpful in the furore that
followed. That was extreme bad luck: I’ve only come across such decisive
camera failure one other time in my entire career.
When the pathologist discussed his worries with the police and the
coroner’s officer, he had to agree that the split inside the baby’s lip could
have been caused by the resuscitation attempt. In the case of these particular
injuries, such a cause would be rare – damage to that part of the mouth is
indicative of abuse – but it is certainly possible that they occurred during
the frantic hour of resuscitation.
The police and the coroner’s officer chose to believe the cause was the
attempted resuscitation and there was no further investigation. They were
dealing with a well-off, professional family, not the kind of criminals or
child abusers they normally encountered.
The baby had been X-rayed and no broken bones found. The pathologist
had taken histology samples and these were pretty much normal. All except
for the very small possibility – certainly not a probability – of some
increase of inflammatory cells in a sample from the lungs.
He might have exonerated the parents by giving SIDS. Or, in view of the
baby’s injuries, he might have aired the possibility of an unnatural death by
giving ‘Unascertained’. Times were changing fast but the fact is, in 1996 he
may also have been working for a conservative, one might even say
Luddite, coroner: in those days any lawyer or medical practitioner with a
few years under their belt could become a coroner. I do not know the
coroner involved in this case but many of them, exclusively those who did
not have a medical qualification, were still struggling with the concept of
SIDS because it was a cause of death based on no definable evidence. And
some coroners also disliked the word ‘Unascertained’, particularly when
applied to babies. They wanted to say kind, comforting things to griefstricken parents, not, ‘We don’t know why your baby’s dead.’ Limitations
like this could leave a pathologist in limbo.
For whatever reason, the pathologist seized on the slides from the lung
sample with their suggestion of inflammation and decided that the baby had
died of natural causes: in fact, lower respiratory tract infection. The child’s
death was treated as natural.
But the following year the Clarks’ second baby died too. He had been a
few weeks premature but he was fine now, at two months old. Sally Clark
breast-fed him and supplemented that with bottled milk. One evening, her
husband went to prepare a bottle for the night feed, leaving the mother to
watch TV while the baby lay in his bouncy chair. When she saw that her
son was limp, she called her husband and rang an ambulance. The
paramedics found the baby dead.
The same pathologist was involved and this time discovered injuries that
suggested to him this baby may have been shaken, perhaps on several
occasions over several days. He believed he had found haemorrhages in the
eyes and spinal cord as well as some abnormalities of the ribs which
suggested that there had been previous fracture or trauma.
Sally Clark and her husband were arrested on suspicion of the murder of
their second child and, while they were being interviewed about his death,
the pathologist quite rightly went back to his report on the death of the first
child. In this he was complying with Home Office guidelines, which state
that ‘if previously held conclusions can no longer be substantiated then any
change of opinion must be promptly and clearly stated irrespective of any
possible embarrassment’.
The pathologist did change his opinion and was to suffer prolonged and
considerable embarrassment.
Examining the microscope slides once again which had, possibly but not
probably, shown a lung inflammation in the first child, he decided that the
cause of death he had previously given was entirely wrong. He decided that
there was no inflammation. He had discovered blood in the baby’s alveoli,
but had not even mentioned it before. He later said he had assumed this was
simply consistent with changes after death. But he had since found that the
nature of this finding might be abnormal and that it was consistent with
asphyxiation.
At this point, as many experts subsequently pointed out, he might have
kept the question open by revising the cause of death from ‘Lower
Respiratory Tract Infection’ to ‘Unascertained’.
One expert witness explained in the later court case why he personally
would have done this:
Unascertained … means that the child’s death may have been natural but without
explanation – perhaps what the jury knows as a cot death. Or it might be that the child
died unnaturally but I can’t find out why, or it might be the child died of a natural disease
that I am not clever enough to diagnose and recognize …
But the pathologist did not choose ‘Unascertained’. Instead he submitted
a further statement saying that he no longer believed the first child had died
of natural causes. The volte face concluded that: ‘There is evidence he died
from an asphyxial mechanism such as smothering.’
Six weeks after her arrest for the murder of her second son, Sally Clark
was also arrested for the murder of her first. At her trial, the jury famously
heard evidence from the paediatrician Professor Sir Roy Meadow, who had
popularized, if he did not actually coin, the maxim, ‘One sudden infant
death in a family is a tragedy, two is suspicious and three is murder unless
proved otherwise.’
A memorable statistic was unfortunately added at Sally Clark’s trial
which was to become associated with Professor Meadow for ever: ‘The
chance of two children dying naturally in these circumstances is very, very
long odds indeed. One in 73 million …’
One in 73 million was a headline grabber and may have sealed the
defendant’s fate. He went on to say, ‘… it’s the chance of backing that longodds outsider at the Grand National … let’s say it’s an 80 to 1 chance, you
backed the winner last year, then the next year there’s another horse at 80 to
1 and you back it again and it wins … you know, to get to these odds of 73
million you’ve got to back that 1 in 80 chance four years running.’
Sally Clark was found guilty by a jury majority of ten to two of both
murders and sentenced to life imprisonment.
I was not directly involved in this case. But it affected all of us. Her
conviction, and David Southall’s work, was indicating that the murder of
babies was much more common than we had all assumed and parents who
murder their children are more common than we would have thought
possible. Even ‘nice’, middle-class professional parents. We pathologists
were called upon to offer a medical and scientific analysis within the
context of society’s current thinking and I’m sorry to tell you that the purity
of scientific truth rarely cuts through contemporary social attitudes.
Personally, I could never forget how I had walked an endlessly wailing,
lactose-intolerant baby around the house, night after night, thinking, in so
far as one can think over the noise of penetrating screams, that I would do
almost anything for some sleep. I knew that the middle classes, even
without the pressures of poverty or isolation, were as vulnerable as other
parents to extreme desperation.
Soon after Sally Clark’s trial, a case of mine reflected what had now
become the great controversy of child protection. When I saw this sixmonth-old baby in the mortuary he seemed to have been healthy and well
cared for, but I was quickly aware of a distinctive triad of symptoms. He
had a subdural haemorrhage, that is, a bleeding on the surface of the brain.
The brain itself was swollen. And his eyes had haemorrhages in the retinas.
These three symptoms, particularly without external signs of injury, were
now regarded as the classic triad of symptoms of what was then called
‘shaken baby syndrome’.
In the 1940s a radiologist, John Caffey, reported multiple fractures of
varying ages in some children and initially thought this was a new disease.
Later research showed the fractures were due to repeated trauma and in the
1960s the term ‘battered baby syndrome’ was first used. Then, in the 1970s,
a neurological variant, shaken baby syndrome, was recognised as a form of
whiplash by neurosurgeon Norman Guthkelch. So these syndromes, and
their root cause in deliberately inflicted trauma, were medically wellknown. However, they were only brought to public attention in 1997 by the
famous case of the medical couple in Massachusetts who had left their baby
in the care of a nineteen-year-old English au pair.
When the baby suddenly became ill and was rushed to hospital, he
showed that classic triad of symptoms and, in a televised court case that
obsessed America, young Louise Woodward was found guilty of murder.
Many Americans were outraged when this charge was changed afterwards
by the judge to manslaughter because he felt that there really was not
sufficient evidence beyond reasonable doubt for a murder conviction. And
that was because medical experts were so divided about shaken baby
syndrome.
This was not the end of the story because by now shaken baby syndrome
itself had become the story. Most people had never heard of it before Louise
Woodward’s trial and suddenly it was in the headlines and every pathologist
was on full alert for the now-famous triad of symptoms.
In fact, as a cause of death it was then and is now highly controversial
and the subject of much scientific and medical argument. Shaken baby
syndrome, now also called abusive head injury or non-accidental head
injury, has created its own angry groups of protesters and deniers. There is
an ongoing search for natural causes to explain it.
Long after Sally Clark’s imprisonment, in 2009, the Royal College of
Pathologists attempted to bring together the various sides of the debate and
this disparate group was able to issue a statement on what they called
traumatic head injury (which was yet another name for just the same thing)
reminding pathologists that, even if all elements of the triad are present,
each may have other, non-traumatic causes. The statement said clearly that
the triad alone is not enough to say a parent harmed a baby ‘beyond
reasonable doubt’: more evidence would be needed for that. And special
care should be taken interpreting the injuries when the baby is under three
months old, because they might, possibly, have been caused during birth.
It looked like a consensus. However, if anything, the debate became more
heated. Forty years after first describing the features of this particular type
of head injury, Norman Guthkelch in 2012 reviewed its history and
expressed concern:
While society is rightly shocked by an assault on its weakest members and demands
retribution, there seem to have been instances in which medical science and the law has
gone too far in hypothesizing and criminalizing alleged acts of violence in which the only
evidence has been the presence of the classic triad or even just one or two of its elements.
At the end of the 1990s, shaken baby syndrome was very firmly on the
pathologist’s radar and the six-month-old baby I saw seemed to show every
relevant symptom. According to his mother, however, he had launched
himself from his car seat, which she had placed on a work surface, with no
prior warning that he was physically capable of doing such a thing. As a
result, he had fallen out of the seat and about one metre down onto a hard
kitchen floor. Even a few years earlier, I would have been reluctant to
believe her. But, post-Woodward, I had very grave concerns indeed.
The mother came from an impoverished and war-torn nation and had
been brought by her husband to live in London with his mother and various
other family members. She spoke no English. Their accommodation was
overcrowded. She still had a relationship with her husband but, because
there was so little room in the family flat, had recently begun to live
separately in housing that had, it seemed, been provided by the council. Her
flat was clean and airy but apart from a bed and a television, she had no
furniture and evidently just sat on the floor.
She seemed to spend all day there alone. Outside the family, whom she
seldom saw, she only knew one person in London and that friend lived far
away. I thought of my desperation with the wailing baby Chris all those
years ago and pitied this woman for the utter isolation in which she lived,
far from home, with this small baby.
She had no car, of course, but carried her son around the flat in his car
seat. When she made meals, she took him to the kitchen and perched his
seat on the work surface. He was not strapped in. One evening she was busy
preparing the food, heard a loud thump (‘a sickening thud’, are words
which often seem to crop up in court), and turned around to find the baby
face-down on the floor. He cried immediately but his eyes rapidly became
staring and his breathing erratic: it was clear something was very wrong.
She tried to phone 999 but was unable to make herself understood. She
tried to phone her husband, who spoke English, but the emergency services
were still blocking the line. She ran down to the street to get someone else
to phone 999 but by that time the police had already responded to her
distressed although incomprehensible call.
They found a baby with blood coming from his nose and mouth, shaking
slowly and losing consciousness. The police would not let the mother get
into the ambulance and the baby was rushed to hospital in an apparently
deteriorating condition. CT scans revealed severe internal injuries, but
initially it seemed he would probably survive. However, his cardiovascular
system became unstable and, in spite of all attempts at resuscitation, he died
twelve hours after his mother had called the emergency services.
So far as we know, natural causes for the three individual symptoms
which are together suggestive of shaken baby syndrome (like blood clotting
difficulties) are very rare. While one should always be alert for these rare
natural causes, I felt that a bleeding, swollen brain and bleeding retinas
indicated that the baby had received a major trauma. Sometimes that trauma
may be an accident, like a car crash. And sometimes, particularly if there
are no external marks, it is not an accident.
In this case, I was further convinced that the baby had been shaken
because, despite the internal haemorrhages, there was no fracture of the
skull, no bruising of the head, no trauma at all on the outside to show that
he had plummeted from a work surface onto a hard floor. He had the triad,
although no trauma to the spinal cord at the neck, which is another
associated symptom.
The mother was tried for manslaughter. The defence pathologist felt that
the baby’s injuries meant he had been subjected to either an accelerationdeceleration trauma (shaking) or a head impact. He did agree that, in a sixmonth-old baby, shaking is the most common cause of such internal
injuries, and added that it is sometimes unclear whether shaking or impact
is the more important factor, since babies who are shaken are then
sometimes thrown forcefully down. However, his overall opinion was that
the brain swelling alone had killed this baby, and that the injuries therefore
confirmed the mother’s story.
Appearing for the prosecution, I had briefed counsel on this and pointed
out the lack of bruising or external mark at all resulting from the alleged
fall. When this was put to the defence pathologist he cited the famous case
of a two-year-old who fell off a stool just about half a metre high in
McDonald’s and died because her brain was so swollen – with no obvious
external injuries.
The jury decided that the mother in this case was not guilty of
manslaughter. She walked free.
A year later she had another son. The local authority knew that she had
been acquitted, but they believed there was still enough evidence to suggest
that the next child might not be safe in her hands. They set in motion care
proceedings to remove the new baby.
In the Crown Court, a mother charged with manslaughter would be
convicted only if her guilt is beyond reasonable doubt. The Family Court,
which hears the local authority’s request to remove her next child from her,
must reconsider her case all over again – but apply a different level of
proof. The Family Court applies the lower standard of proof – the balance
of probabilities – to reach its conclusions. That can be defined as a 50.1 per
cent chance of guilt – a ‘lower’ standard of proof than the standard of proof
that is beyond reasonable doubt. So, different courts can reach different
conclusions based on the different levels of proof they require, and it often
happens that the Crown Court does not have enough evidence to convict for
the death of a child but the Family Court feels there is sufficient evidence to
remove the living sibling of that child. And so, truth, that elastic commodity
I once thought so immutable, becomes a question not of fact but of
definition.
No one can be criminally convicted because they are guilty ‘on the
balance of probabilities’. Even if the Family Court decides, using this
definition of guilt, that a parent has ‘most probably’ killed their child, the
parent is free. And, because these courts are entirely closed to press and
public, no one will ever know. Although they might be aware that the court
has ordered any surviving or future children be taken away, or that some
other safeguarding option has been chosen for them. The Family Court’s
sole aim is not to jail parents, it is to safeguard children, and that is what
happened in the case of the woman who said her child had fallen from his
car seat.
For pathologists, the chasm between two courts and two standards of
guilt can be a nightmare. According to our evidence about the death of a
first child, innocent, bereaved parents may never be allowed to keep future
children. Or alternatively, we may be exposing a second child to a killer
parent.
The universal tendency to leniency where mothers are concerned, of
which everyone, including me early in my career, has been guilty, is a
symptom of the deep human compassion most people feel for parents under
pressure. I only have to think of baby Chris to feel that same compassion
right now. If poverty had been knocking at my door, debts climbing in the
window, chaos pervading every air molecule in the house, would I have
been able to bridle my exasperation? Without the luxury of a quiet place to
escape to in the house, would I have been able to stop exhaustion and strain
spilling into fury?
Compassion certainly has its place but, in the case of child abuse, we
must extend our compassion to those who may not yet even be born. When
society, when pathologists, finally realized how widespread child murder
and abuse was, each baby death assumed a double importance. Justice for
the deceased, yes. But the safety of other children in the family became
paramount. Our tendency to leniency no longer had a place.
Sometimes, a year or more after a baby has been buried, we return to the
file because another child has been born and there is the question now of
safeguarding the living. By that time, a fuller picture of the baby’s life and
death may have emerged. Parents’ abusive, neglectful or simply absent care
may have been exposed or histories uncovered. The whole case has a new
slant. So we reopen the file and review it. Of all the files I revisit, baby
cases, that minefield of moral and emotional ordnance, are the ones I
examine and re-examine the most. When I moved to St George’s I would
have liked simply to avoid them, but as the 1990s wore on it became
obvious that the question of babies and why they died was at the heart of
forensic pathology and must be addressed by everyone, including me.
28
There was another change in our profession, one that seemed to accelerate
at an alarming rate when I arrived at St George’s: the stress involved in
court appearances.
Forensic pathologists of the past were household names and every
newspaper reader between the wars knew who Sir Bernard Spilsbury was: a
sort of Sherlock Holmes figure whose brilliant analysis of any case ensured
that, if he were appearing for the prosecution, the defendant would be
hanged. Long after his death, the icon’s cases were re-examined and his
logic found sometimes to be less than Holmesian. But at the time it was
unthinkable to challenge him.
His successor was my own hero, Professor Keith Simpson. Simpson –
whom, at the end of his career and beginning of mine, I had actually
breathlessly watched carrying out a post-mortem – was a man with far more
humanity and humour than Spilsbury. But he, too, operated in the days
when the expert witness was held in such regard that he was rarely
challenged.
In my early years of practice, court appearances hadn’t been too bad. In
the first months I avoided controversial cases if I could, although it was
hard to know in advance what would turn into a circus. In general, counsel
just wanted the facts from the pathologist: there was then still, if not the
respect of earlier ages, at least its residue.
However, by the time I reached St George’s, barristers had begun to see
post-mortem reports as a possible chink in the opposition’s armour and
more and more regarded the testimony of the expert witness as an
opportunity to stick the knife into the other side. Some pathologists enjoy
this. For anyone with macho pretensions, courtroom barracking is the
professional equivalent of a Saturday night fight and there are many who
are ready to roll up their sleeves. Watching their courtroom appearances
would leave me open-mouthed and incredulous.
QC: Do you mean to tell me that you are absolutely sure that the knife wounds were
inflicted while the deceased was lying down?
CONFIDENT COLLEAGUE: I do.
QC: You are certain?
CC: I am.
QC: But are you aware that we have heard from two witnesses that he was last seen
walking down the Old Kent Road?
CC: I am aware of all witness statements.
QC: Then will you perhaps entertain the possibility he –?
CC: I will not.
QC: You will not even say there is a possibility that –?
CC: I am sorry that I have to remind you I have sworn an oath today. An oath to tell the
whole truth and nothing but the truth. Therefore, you can produce a witness saying
the deceased was playing premier league football or that he was walking down the
Old Kent Road or anything at all, but it is still my duty, my oath, my role as an
expert witness, to tell the truth and only the truth as I see it. (sonorously) And
therefore I tell you that this man was stabbed as he lay on his back.
How I envied that colleague. I knew I could never be like him. In those
circumstances I cannot but admit the possibility, however slim, that I may
be wrong, that there are other explanations, other versions of the truth.
While my job requires me, at the same time, to insist that I have reached the
correct conclusion.
My favourite court was the one that, in theory at least, is non-adversarial
and informal: the coroner’s court. Here, the coroner is leading an inquiry
into the truth. Here is the deceased’s wife, sitting an arm’s length away, redeyed, anxious for the truth but fearing it, still shocked many months after
the death. Here are the deceased’s children, tearful, angry, telling the
coroner they don’t think it was an accident and they have a good idea who
was involved. Here are his friends, awkward, supportive, overawed by the
court setting.
I turn to the relatives in order to explain, as simply, kindly, clearly as I
can, causing as little pain as possible, how the deceased’s life ended. I
answer their questions. I nod sympathetically. Often, they ask the same
questions again and again as if they can’t hear the answers, no matter how
hard they listen. The coroner thanks me and I return to my seat.
As I leave, some relatives catch me to ask the same questions. Again. I
tell them once more that he really didn’t suffer, the end came quickly, he
probably did not have time to comprehend what was happening, he was
otherwise in good health, no, there was no evidence of cancer and the chest
pains he used to complain of were not caused by heart disease.
Usually, the coroner then reaches a verdict. Accidental death, suicide,
natural causes, misadventure, unlawful killing … the relatives leave feeling
emotionally exhausted but with a sense that death’s formalities are all over
now. They have listened and have, hopefully, been listened to. The
deceased’s case has been fully examined in public and the reason for and
fact of his passing officially stated.
If only the criminal courts had the same degree of humanity. There are
few jobs where it is routine to stand up in public and defend your
professional opinion in the face of very personal attack. There are, of
course, expert witnesses who get the reputation of being a liar for hire. I’m
not one of them and don’t like to be treated that way by solicitors asking if I
might alter my view a little or delete an inconvenient paragraph in my
report. When I chose this career, I thought that I would be conveying the
truth about the dead to the living – who would be grateful to hear it. But, as
we approached the new century, I instead was starting to feel like the
faithful dog that proudly lays a stick at the feet of his master only to receive
a hearty kick for his efforts.
Despite all this, I usually go to court feeling confident. I know my
subject, I know my findings, I know my conclusions. But, once in the
witness box under oath, I have no control over events. The barristers are in
control, and when they say I must stay and answer questions, if there is no
intervention from the judge, then stay I must.
Not long at St George’s, I had an experience in the witness box which
was so unpleasant that it gave me many sleepless nights and seemed to
point at things to come. I had no idea, when I performed the post-mortem
on a ‘rent boy’, or teenage male prostitute, that this case would not be
straightforward. He had been found the night before and had died in
hospital. His body looked extraordinary. He was covered in livid bruises,
and I do mean covered. He was virtually a definition of that old threat
adults shouted at naughty children in my day, ‘I’ll beat you black and blue!’
I counted 105 bruises and many, many abrasions. The weapon used was a
cylindrical metal bar from a set of weights. The bar had cross-hatching at
the ends, which was reproduced in some of the wounds. There were
abrasions also, where, it seemed to me, the circular end of the metal bar had
been used in a sort of stabbing action.
It is unusual for someone to die of bruising, but the nineteen-year-old
victim had sustained a remarkable number of blows. I gave the cause of
death as multiple blunt trauma. In fact, once the patient arrived in A&E he
developed a disorder called disseminated intravascular coagulation, which
arises from the overactivation of the body’s defence system against trauma:
this results in the blood-clotting mechanisms being overwhelmed and so
further, almost continuous, bleeding takes place everywhere, including from
vital organs. Shock follows and, in many cases, death.
I went to the block of flats where the events took place. The young man
had been found on the third floor, but he had been beaten on the ninth floor,
so he had somehow staggered down seventy-four stairs before collapsing. I
measured the steps and the risers but it was clear to me that his injuries,
except possibly for one or two where he had stumbled on the stairs, were
caused because he had been beaten by the iron bar, and not because he had
fallen downstairs.
The defendant, also a male prostitute, also about nineteen years old, was
actually the deceased’s best friend, and they shared the same ‘uncle’ who
pimped them or funded them or both. It has amazed me, over the years, how
frequently men (but not noticeably women) will kill their best friend. And
brothers commit fratricide even more frequently. In this case, the deceased
went to the defendant’s flat. They drank all afternoon and evening: the dead
lad’s extrapolated blood alcohol levels were around twice the drink-drive
limit. It was just before midnight that a resident on the third floor called an
ambulance: she had found the victim lying injured outside her flat. He was
taken to hospital but died less than twelve hours later.
What had happened?
In my opinion the friend started to hit the deceased and just could not
stop. Eventually, the deceased escaped from his flat and down the stairs. If
his attacker had reasoned at all he had probably reasoned that no one ever
dies of thumps and bruises – which is a fallacy.
I received notification that I was being called by the prosecution as an
expert witness. That was routine. And it felt like a routine case. I did learn
that the defence barrister was one I recognized, a particularly persistent
tiger. An old tiger, actually. But not without teeth. He was known for
stalking expert witnesses but I was still not really concerned. The case was
quite straightforward and I’d probably be in and out of the witness box in a
few hours.
At a pre-trial conference with the prosecution, counsel had warned me
that he would be going through each of the 105 injuries with me. I hoped
that after such a marathon it would be so obvious to the jury why the young
man had died that the defence would have no further questions and I would
be allowed to go.
I took the stand and made my oath. The court had been supplied with
copies of some of the post-mortem photos: not as sanitized as the cartoonish
images we use today, but nothing too horrific, and each area of bruising was
documented and numbered. I had prepared these photographic exhibits and
given them to the Crown Prosecution Service well in advance, but, as usual
where pictures are concerned, there was a lot of bumbling about. Officials
stumbled blindly here and there with the wrong pictures, judge and jury
found they had different ones, people passed pictures to other people and I
had to suppress hysterical laughter at the sheer disorganization of it all.
Prosecuting counsel began by lulling everyone to sleep as we discussed
in detail, as previously agreed, each one of the 105 injuries. In the course of
this, I made two small errors, both picked up in a kindly way by prosecuting
counsel. The first was on injury 11 on the right-hand side of the back.
ME: … indicating that once again that injury has been caused by a linear blunt object of
similar size to the object that caused the injuries on the left-hand side of the chest.
QC: When you refer to the chest, you mean the back?
ME: Oh, I do apologize, yes I did. Those injuries I have just been talking about are the
highlighted injuries to the back.
A daft error. And idiotic when I did it again, much later:
ME: … and as you can see, injury 71 is a ten by three centimetres deep bruise.
QC: Now, did you not, in your report, in addition to those numbered injuries, find
something else here?
ME: Indeed, once again as with the chest, I found some area of parallel bruising over the
legs.
QC: As with the back?
ME: As with the back. I am sorry. You are quite right, I am confusing the back and the
chest. Over the back were, at least, three areas of parallel bruising …
Considering the enormity of the crime we were discussing, these
mistakes seemed small enough. I said back when I meant chest and was
corrected. I don’t think I confused the judge, jury, prosecution or defendant.
Counsel for the defence, however, must have been rubbing his hands.
When the judge asked the defence how long their questions would take,
because he was deciding when to give the jury a break, the old tiger said,
rather ominously, that, since new material had just emerged, it would
perhaps be better to have the break now.
There was a twenty-minute pause, one that chess players might regard as
strategic. I spent it wondering just what the new information was. Was it
something I had said? I remembered defence counsel’s reputation and, sure
enough, within a few minutes of our return …
Defence QC: You have, I think, on two occasions, referred to the chest when you meant
the back?
Oh-oh. When a QC tries to catch me out on small and insignificant errors
to prove to the jury my incompetence early in the cross-examination, then I
know that there’s trouble ahead.
ME: I did indeed, yes.
QC: That is a mistake that can be easily made, can it not?
ME: Well, yes, it is easy to confuse these things. I tend to consider the back of the chest
and the front of the chest.
QC: But, Dr Shepherd, that is not what you said.
ME: No. I mistakenly said chest when I meant back.
QC: Quite a mistake in its way, is it not?
ME: Well, it is a mistake. I’m not sure how ‘quite’ a mistake it is.
QC: Very well. When you are more precise though, perhaps you expect a higher degree of
accuracy. For example, the weight of the metal bar (referring to the murder weapon
here) – 450 grams. Is that right?
ME: That is what my notes say.
QC: Well, we shall be hearing, no doubt, an admission of evidence that it was 421 grams.
Not a great deal turns on the weight, except the accuracy of what you say.
I felt myself turning red at this point. Confusing chest and back wasn’t
serious but being accused of getting the weight of the alleged murder
weapon wrong might look careless to a jury. No time to think about it;
defence counsel, without warning, entirely changed subject.
QC: If a man had some drink – it all depends how much, and whether he is accustomed to
it – it may affect his steadiness of gait?
ME: It may.
QC: And, if he has suffered some physical trauma – blows – that will not improve
matters, will it?
ME: Well, I think that depends on the blows he has received.
QC: Now, Dr Shepherd, you said the deceased had received about a hundred blows, is
that right?
ME: (very carefully now) That is … an approximation.
QC: Now follow this through as a logical thought, would you please. You are a doctor,
called to a flat on the ninth floor. You have been told and you can see a man has had
… let us take your evidence at full strength … 105 blows. He says, ‘I want to walk
down to the third floor. I know I had a drink.’ There are seventy-four steps and eight
and a half landings. Would you say, ‘All right, old boy, get going. I’ll see you at the
bottom?’
If I hadn’t been under oath and giving evidence, I might have laughed.
Would the QC, on finding himself on the ninth floor of a block of flats with
a drunken young male prostitute, really address him as ‘old boy’? But the
real concern for me was: where was this going?
After an endless series of further questions about if, how and why I
would help a drunken rent boy down the stairs in the middle of the night,
the QC exploded in a manner oddly reminiscent of my father.
QC: Can I come straight to the heart of the matter and not pussyfoot around answering
and questioning? You would have wanted to make sure he did not fall down the
stairs – seventy-four of them – would you not?
ME: That would be one of my concerns, yes.
QC: Yes. Because if a man had been subjected to the number of blows you indicated, he
might fall?
ME: Clearly, anyone in that circumstance might fall.
QC: Thank you. If he fell on uncarpeted stairs, he might injure himself?
ME: Certainly, a fall onto the lower stairwell I saw could result in injury, yes.
QC: Yes!
Good heavens. Surely the defence was not going to argue that the 105
injuries were virtually all caused by the victim falling downstairs? Surely he
would not try to persuade the jury that this was not a murder with the metal
bar but just an unlucky series of falls? The idea was absurd.
Counsel asked me to describe the stairwell in minute detail, although in
fact the jury had been given pictures of it. I lost count of the number of
times he repeated how many stairs there were. I think everyone in court
must have dreamed about the number 74 that night. And a fall down these
seventy-four concrete stairs, he kept insisting, could be very serious. I was
unable to contradict him. But I didn’t believe the deceased’s injuries, or at
least the fatal ones, resulted from falling downstairs.
Then he went back to the injuries. Individually. Again. All 105 of them.
One by one, he asked me to prove they had not been caused by the
deceased’s alleged fall, and one by one he challenged each answer.
This cross-examination amazed me. The deceased had been a drifter who
had lived most of his childhood in and out of care, had probably spent at
least some of his subsequent time living on the streets and had recently been
released from jail. The defendant’s background was very similar. If either
one had ever received a fraction of the public money, care and interest
which was devoted to this trial then I doubt there would have been a
murder.
As for the defence barrister, it was good he was working so hard to
defend a client who was clearly from the margins of society. Had he ever
passed the lad huddled in a doorway, I don’t expect learned counsel would
have looked at him, let alone thrown a coin in his cup. But now the young
man was on trial for murder, legal arguments about him consumed the
barrister. I wished he could do his job without attacking my reputation as an
expert witness. But I knew that in another case and with another jury we
might be on the same side and then, instead of excoriating me, he would be
praising my experience and skills.
The cross-examination continued for the rest of the day and then carried
on the next morning. And the next afternoon. And the following morning.
Now the defence QC wasn’t just arguing that the injuries were caused by
falling downstairs but that the cross-hatching from the surface of the iron
bar reproduced on the victim’s skin was actually simply caused by the warp
and weft of his cotton T-shirt.
Then, many tea breaks later, as I returned to the witness box ready for a
few more rounds with my back against the ropes, I watched him bounce in,
a spring in his step and his eyes darting dangerously beneath his wig. I
knew the tiger was planning to pounce.
QC: Alcohol, I suppose, if you are affected by it, will make you, perhaps, slightly more
liable to bleed than would otherwise be the case?
ME: In the chronic alcoholic whose damaged liver may have blood-clotting problems,
yes. But I found nothing to suggest that is the case here. I believe alcohol would
have a very minimal effect.
QC: Do you know anything about that as a clinician?
ME: No, I do not.
QC: Not aware of that?
ME: Not particularly.
QC: What do you mean, not particularly? Are you aware of it?
ME: I am not aware, throughout my experience, of anyone who has suffered significantly
more bruising when they are under the influence of alcohol than someone who is
sober.
That was not the answer counsel wanted to hear. He argued and argued
with me that alcohol dilated the tiny blood vessels on the surface of the skin
– which I agreed with – and therefore that drinkers were much more
vulnerable to bruising – which I did not. I lost count of the number of times
he took me, step by step, through his logical but erroneous deduction that
the victim was covered in bruises simply because he had been drinking. I
really began to doubt who had been beaten by an iron bar, the victim or me,
but I stuck steadfastly to scientific fact. Finally, the QC exploded.
QC: Where do you get this from? Can you do some research overnight?
ME: I can consult the preclinical medical textbooks about the effects of trauma on the
skin.
QC: What book do you suggest I consult overnight?
ME: I would suggest you consult any molecular biology book, I’m afraid I cannot give
you a name.
QC: Aren’t you familiar with any?
ME: Perhaps a textbook by Guyton will help, I cannot tell you which edition is current, I
think the third or fourth edition. Or any haematology textbook will cover it.
QC: Any haematology author you can name?
ME: Not specifically, no.
JUDGE: How many pages is counsel likely to have to read, Dr Shepherd?
ME: I’m afraid I cannot help you with that.
QC: It is beyond me, but I shall still have a look.
JUDGE: Yes, and pass it to me afterwards, please, Counsel.
QC: I will, M’Lud.
By now I hated both the QC and the judge and suspected that they were
members of the same chambers, or at least the same London club. Once,
when the judge showed impatience with the defence, the QC asked to speak
to him without the jury present. The jury, press, public and I filed dutifully
out of the courtroom. When counsel and judge are talking in this way it
usually means that a point of law is being argued and, on returning, there is
a distinctly chilly atmosphere in the court, with one barrister smiling and
the other sulking. But these QCs and this judge were all smiling happily
when we returned, like pals at a fireside.
The defence was trying to explain away the horrific beating the dead lad
had received by persuading the jury he had fallen downstairs (did I mention
that there were seventy-four stairs?) and in the course of this he had become
so badly bruised because he’d had a few drinks. I spent the evening
feverishly phoning friends to discuss bruising and searching the hospital
library for that textbook.
The next day we were at it again. It was all I could do to contain my own
homicidal feelings.
Defence QC: You referred me and the court to a textbook. Guyton.
ME: Indeed.
QC: Have you got it with you now?
ME: I have a copy now.
QC: Do you have the passage you relied upon?
ME: I have marked the page that deals with what happens in the body following damage
to a blood vessel.
QC: You’ve got it there?
ME: Yes, in this particular edition it is chapter 36.
QC: Which edition?
ME: I believe the eighth.
QC: Hmm. You had, of course, referred us to the third or fourth edition.
ME: I think I said I did not know which edition is most current.
QC: May I see it?
But I think he had already seen a copy. He asked me endless questions
about platelets and clotting in an attempt to prove his point until the jury
was nodding off and even the judge interrupted.
JUDGE: Please forgive me, but what I would like to ask Dr Shepherd is: this chapter you
referred to – is there something in there which actually says alcohol increases
bruising?
ME: It is the absence in that book, M’Lud, and in other books I have consulted, of
anything saying alcohol causes increased bruising. It is the absence of those facts.
JUDGE: Because, if this was a sustainable proposition, you would expect to find it in that
book, at that chapter?
ME: I would indeed, M’Lud.
That didn’t really stop the defence. The QC made his false point in a
variety of ways, once, twice, three times more, that alcohol increases
capillary blood flow and so bruising must be more likely.
A whole week after I took the witness stand, I was allowed to go. What a
relief.
This case illustrates that there are facts – and there are the conclusions
that can be drawn from them. In the adversarial cauldron of that courtroom,
truth had turned into an individual, nuanced, malleable commodity, and that
is why as an expert witness I was pressured to interpret facts in ways I
found uncomfortable. Advocacy – the art of a lawyer making his case –
need have no conscience and any Bar school would agree that some good
cases are lost by poor advocacy and that some poor cases are won by good
advocacy. Overall, the balance of justice relies on a concept that has served
our society well for centuries: that twelve people drawn randomly and with
no special training can listen to and form a judgement based on all the
evidence they hear.
In this case, the jury found the defendant guilty of murder and he went to
jail. I wonder if he had as many sleepless nights as I did. But at least it was
over.
Except it wasn’t. After his client had spent a couple of years in jail, the
barrister sought leave to appeal against the conviction because he had new
evidence. The new evidence was that I had failed to produce any textbook
in court which would contradict the QC’s theory that alcohol intake was
responsible for the deceased’s bruising after he fell downstairs. And he
listed a number of other ways in which I had allegedly been incompetent.
Now I certainly began to wonder who was being tried: me or the
convicted murderer. But I did have time to muster some support. A very
senior haematologist read the trial transcript and wrote a report, which
concluded: ‘Alcohol-induced skin capillary flow would have played at most
a trivial role in the skin haemorrhage (bruising). This spectacular red
herring was pressed hard by the defence in the name of common sense but
the image conjured up, of vessels bloated with blood, is misleading.’
We spent quite a lot of time hanging around the Court of Appeal before
the defence’s case was heard. Then it was all over in an instant. The
spurious ‘new evidence’ had been seen by their lordships for what it was
and leave to appeal was not granted.
I admire the persistence of that QC in fighting for his client, a very
disadvantaged young man. If I were ever accused of murder, then I would
want him defending me. As an expert witness in his firing line, however, I
felt he had shown a remarkable ability to ride roughshod over medical facts
which did not favour his case.
Since then, if I am in court and the going gets tough, my coping
mechanism is Alexander Pope. The lines my father wrote so painstakingly
for me in that dictionary all those years ago instructed me to speak
diffidently even when sure I am right, to readily admit the possibility that I
may be wrong, to examine my errors and admit to them, to teach or correct
others with generous regard for their feelings, never to agree for politeness’
sake with concepts I know are wrong and to accept correction when it is
appropriate. Despite the aggression and single-mindedness our adversarial
system fosters, and its frequent disregard for the truth, I try to hold to
Pope’s principles.
29
Just thinking about the Hyde area of Manchester always gives me a warm
glow. It was here that my mother had been brought up, it was here that her
family and friends had lived. It was a place of happy visits when I was
small and a place of pilgrimage all my life, too, because my mother was
buried here.
It pleased me to think of the old ladies who came from Hyde – my
grandmother, my aunt – who were so unlike the isolated, undernourished
elderly people whose bodies I sometimes saw. They always welcomed me
with warm and caring arms, drawing me into their busy lives and polished
homes. They were noticeably an intrinsic part of a wider community.
In 1998 I received a call from a defence solicitor asking me to perform a
second post-mortem examination on just such a lady from just that area.
Mrs Kathleen Grundy had been known to my mother’s family as a friend
and schoolmate of my aunt. She had died on 24 June and on 1 July she had
been buried in the same cemetery as my mother.
In August, however, she had been exhumed and now I stood over her
body in the mortuary of Tameside General Hospital.
She was eighty-one but appeared to have been in exceptionally good
health. There were no signs of a struggle. And, unusually for anyone her
age and for the next generation too, her arteries showed only minimal
atheroma.
But toxicology told a different story. Although I could find no injection
site on her body, she had evidently consumed a substantial dose of
morphine or diamorphine in the hours leading up to her death. I gave as its
cause: overdose of morphine.
In fact, she had died at the hands of her trusted family doctor, and it was
through her sudden death that Harold Shipman was finally revealed as a
serial killer. He was highly regarded by his patients, discussed and admired
in that community I remembered with such fondness. Many described him
as the nicest doctor in the area. He was especially loved by the elderly
because he was happy to make home visits and, having worked in Hyde for
some time, when he set up his own practice in 1992 he was inundated with
patients by word-of-mouth recommendation.
Suspicions about him were aroused by Kathleen Grundy’s sudden death
just days after her will had apparently been changed to favour him. He had
certified her cause of death as: ‘Old Age’.
Further cases were immediately opened and more exhumations followed.
I attended five of these post-mortems. The next I saw, a seventy-three-yearold, had very mild coronary disease and mild emphysema. She cannot have
had pneumonia, as claimed by Shipman on her death certificate. She did,
however, have morphine poisoning. The next body told the same story.
They all did.
It seemed frankly incredible that a family doctor could have killed six of
his patients. In a letter I wrote afterwards I said:
It is clearly essential that the source of the morphine is identified and the possibility of
contamination must also be considered … given the delay between death and postmortem examinations and the numerous events and actions that have surrounded these
bodies, the possibility of contamination needs to be positively excluded … I would
suggest that advice is sought from a chemist to see if it is possible for chemicals used in
the manufacture of embalming fluid, coffin wood or coffin furniture to be contaminated
by substances containing morphine whilst buried … finally, the possibility of other links
between the bodies should also be explored (embalmers, undertakers, staff).
Of course, I thought every other possibility should be investigated not
just because I was pathologist for Shipman’s defence (yes, even serial
killers are entitled to a defence) but because I was, we all were, resistant to
the idea that a doctor had systematically killed his patients. A few years
later, when Shipman had been imprisoned for the murder of no fewer than
fifteen patients, it was hard to stomach the conclusions of Dame Janet
Smith’s public inquiry – that he had, over more than twenty years, certainly
killed 215 people and there were hundreds more cases for which it was
impossible at this stage to ascertain the facts.
His reasons are unclear. Generally, his victims lived alone. Generally, but
not always, they were elderly. Generally, but not always, they were women.
Anybody hoping that Shipman would eventually reveal the reasons for his
actions – and perhaps confirm how many of the 494 deaths which had
occurred on his watch he had actually caused – had their hopes dashed a
few years later, in 2004, when he was found hanging in his cell.
Hyde changed for me after the exhumations. Instead of being a place I
associated with my mother’s family warmth and bustling old ladies, it
became a place where old ladies lay dead at the hands of a serial killer they
had trusted to take care of them.
When I returned to London from the exhumations, still half disbelieving
that small part of Shipman’s crimes we then suspected, I had another
unpleasant experience: I crossed swords with Iain West. To my amazement,
he had retired from Guy’s. After all those years of swearing he would never
stop, he had done just that. The rumour was that Iain was unwell but, of
course, it was impossible for him to disappear from the London murder
scene and just tend his garden in Sussex. He popped up frequently in the
mortuary and in court, and when I returned from Manchester, brooding over
the unfolding truth about Shipman, I found that he was to be my adversary
in a knifing case.
We disagreed fundamentally: not by meeting face to face but by writing
strongly worded, contradictory reports. His rebuttal was, as usual,
extremely robust. Although it did occur to me at the time, and not just in
retrospect, that his prose was a little less robust than it used to be.
The case centred on the perpetrator’s account of how the knife entered
the heart of the victim. Such accounts are often highly creative and by now
I think I had heard every excuse in the book for the presence of a blade in
another person’s body. The most common is the claim that ‘he ran onto the
knife’. This is not always easy to prove or disprove and I need as many
witness accounts as possible to help me reconstruct the attack. On this
occasion, there were none. A woman and her husband had argued, the
outcome was his death, and we only had her word to go on. The senior
investigating officer actually phoned me for advice before interviewing her,
a rare enough event, but he knew the entire case did rest on her exact
description of what happened.
I said, ‘Don’t give me generalities, pin her down. Don’t let her tell you:
“He just came at me!” That means nothing, so get her to re-enact it,
describe it, say who was where and how she was holding the knife, which
hand did she have the knife in and in which direction each of them moved.
Then I might be able to prove or disprove her story.’
He did exactly what I asked. This case, however, remained a conundrum.
The divorcing couple were arguing very acrimoniously over which of
them their two young sons should live with. They were well off and their
house was large and well cared for. The father wanted the two boys
desperately and a Family Court hearing was imminent. They were all still
living in the same house, although the mother had arranged to take a rental
property for herself and the children which they would move into shortly.
On the day of his death, the father had taken time off work to go out with
the children. The mother was waving them goodbye when he suddenly
stopped the car in the driveway and went into the house, gesturing for the
mother to follow him. Thinking he had forgotten something, she did so. The
father shut the door behind them and announced that he wanted the children
to live with him.
According to the wife’s statement, here is the argument which followed:
I said: ‘But you go to work, how are you going to do this?’
And he said: ‘I’m going to resign. And I’m going to take care of my children.’
I said: ‘Oh no you’re not.’
The wife then described her husband’s fury. Its tell-tale sign was the way
he twisted his jaw: she remembered this from one previous occasion when
he had hit her. But, as she made clear, despite the middle-class lifestyle she
was a tough cookie from a tough area and had learned early in life that
cowering only encourages bullies. So on that previous occasion she had hit
him back and now she was ready to do the same.
She was unable to explain how the couple had moved from the hallway
to the kitchen.
But the next thing was when I was at the back of the kitchen and I thought he was
punching me in the stomach. He started punching me in the stomach and I thought he was
hitting me but when I looked, I looked down and I saw a green handle and he wasn’t
punching me, it was stabbing me.
I said: ‘What are you doing, you’re trying to kill me!’
And he, then he got it, got the knife from my stomach and he started shoving it into my
neck. He was trying to cut my throat. He was trying to get my artery cut in my throat so I
would die …
And I said to him: ‘For God’s sake, you’re trying to kill me, think about the boys …
don’t, don’t kill me, think about the boys … you can have the boys … have the boys, just
please don’t kill me.’
It didn’t occur to me that he might get another knife or anything but then he started
kicking me. He got my head and banged my head on the floor. I got a bruise here and he
broke a tooth. He’s banging me and banging me and he got a kitchen chair and he hit me
with the chair and I just thought, my God, he’s not going to stop until I’m dead. I’m half
dead already with all these wounds. I was soaked in blood. I felt like I’d, I’d, been in the
shower I was so covered in blood.
He wasn’t saying anything, he was just shoving it into my neck and I had to get that
knife off of him … he was holding me here and shoving it into my neck and I, with my
right hand, I got hold of the handle or the blade or whatever it was and I just held on to it
… there was blood everywhere, all over the floor and the wall.
And I had, had, already had the knife in my hand, my right hand, so I swiped. I either
went forward or I swiped with the knife … I must have either slipped or I went down on
the floor and I was cowering over the knife …
The interviewer stopped her there and asked her to act out exactly what
happened, more than once. He was able to establish that she had waved the
knife in the air as she sat on the ground, but she was unable to describe the
contact between the victim and the knife. Indeed, she had no reason to
believe she had killed her husband because he ran out of the room. She
rushed to the garage, locked the door and called the police. And throughout
this, the two little boys were strapped into their car seats in front of the
house.
Was she telling the truth? Or had she killed him and then injured herself
to substantiate her story that he had attacked her?
Pictures of the scene confirmed her claim that there was blood on the
kitchen walls and that it was thick on the floor. Chairs were upset. It
certainly looked as if there had been a fight here.
The husband had various injuries:
– A superficial incision of his upper chest.
– A wound that penetrated three centimetres into his left, lower leg.
– Two slightly deeper, small injuries on the palm of his right hand.
– A stab wound to the heart that had penetrated the anterior wall of the right ventricle and
left a smaller injury at the apex.
He had been rushed to hospital and extensive heart surgery had been
attempted, so there was a lot of suturing. The surgery was eventually
unsuccessful and, of course, it was this wound to the heart that had proved
fatal.
However, at a superficial glance, his injuries did not look as bad as his
wife’s. I did not meet her or examine her myself; instead I reviewed the
many photos taken of her wounds. I was looking for self-inflicted injuries,
the sign of a murderer who plans to plead self-defence.
Pathologists frequently have to decide between homicide and suicide,
accidental and deliberate injuries. And knife wounds are the realm of the
faker: they look so horrible that at first glance the inexperienced must
immediately believe that no one could possibly do that to themselves. I
have learned over the years, however, that there is almost nothing people
will not do to avoid a murder charge. Self-inflicted injuries are generally
recognizable: they are created with the minimum force to create maximum
effect, and obviously they are always in parts of the body which are readily
accessible to its owner’s hand. Injuries which cannot possibly be selfinflicted are also identifiable, and, because of this, I am sometimes pleased
to help relieve the innocent of assault charges.
The wife in this case had:
– Bruising to her left upper arm, left shoulder, left side of neck, right hip, left hip, right
thigh, right hand.
– A gaping incised wound, but not a deep wound, on the front left side of the neck.
– Superficial scratches in the same area.
– A puncture wound by the neck wound.
– An incision over the collar bone.
– Incisions on the back of the left elbow.
– A horizontal incision under the right breast.
– Short stab wounds on both sides of the abdomen.
– A puncture wound in the right thigh.
– A gaping incision on the right hand.
– Short, superficial cuts on the right thumb.
– A knife graze on the left hand.
– A broken tooth.
The Crown Prosecution Service had many meetings about this case.
When the late husband’s family picked up the possibility that the wife
might not be charged, they furiously talked of a civil prosecution. They
hired Iain to write a report comparing the description of the fight the wife
had given the police with her actual wounds.
And here was his report, waiting on my desk when I returned from
Manchester. It was so thunderous that it was practically rumbling.
The blunt injuries to the arm could have resulted from a series of blows to the arm. The
pattern does not appear to be typical of gripping …
While it is possible for individuals to produce bruises on their own body by striking
themselves with objects or by pinching etc., in this instance the injuries on the arm could
be the result of an assault by the husband.
The overall pattern of her injuries, however, is not at all typical of the type of wounds
which would have been sustained if there had been a vigorous assault by the deceased
who had been attempting to stab her. Skin is one of the toughest tissues in the body and
once the tip of a knife has pierced skin, assuming even a moderate degree of force behind
the thrust, there would be nothing to stop the instrument from penetrating deeply into the
body: in many instances the blade penetrates to full length. All of the wounds seen on this
lady’s body appear to be very superficial and there does not appear to be any substantial
degree of penetration.
Self-inflicted, incised wounds in the neck are not uncommon. There is no evidence to
suggest that the knife had been thrust into the neck in a stabbing motion. Given the
manner in which the wounds were alleged to have been caused on her abdomen, I am
firmly of the opinion that they are not consistent with deliberate forceful knife thrusts but
are consistent with self-injury or stab injuries inflicted under considerable control.
This lady may have been the victim of an assault involving blows such as punches or
even blows from a chair, although I can see little evidence to sustain an allegation of
heavy kicks to the thighs or of the head being forcibly struck against the floor. The
overall pattern of the wounds is, however, consistent with self-injury.
I agreed that the wife had been subjected to a blunt trauma attack. I
disagreed that the knife wounds were self-inflicted.
I gave several reasons for this.
First, when she was stabbed in the abdomen she had described this as
feeling like punches, not like being cut or stabbed at all. This is a very
common misperception of an individual who is stabbed: time and time
again I have heard victims say that they could just feel a punch rather than
the knife itself penetrating. This is a fact, but it is not the kind of fact that
the wife is likely to have known.
Second, although she could have injured her own neck and abdomen, it
would be very difficult and most unusual for someone to injure the back of
one elbow and the back of the opposite hand.
Third, it was the husband’s injuries that were most important and, of his
four stab or incised injuries, three were in non-lethal areas of the body. The
unusual stab wound to the leg did suggest that his wife was on the floor
when it was inflicted, or anyway she was low down. The fatal wound to the
heart may have been inflicted deliberately, but in the context of a struggle
for control of the knife I felt that it was not possible to exclude beyond
reasonable doubt the possibility that the wound was inflicted accidentally.
And no one could maintain, from the blunt trauma injuries on the wife, that
there had not been a very serious struggle.
So, although the case was full of doubts and discrepancies, as an expert
witness I couldn’t state beyond reasonable doubt that the fatal stab wound
to the husband was deliberate or that the wounds to the wife were selfinflicted. Even on the lower level of guilt, the balance of probabilities, I felt
that it was the husband and not the wife who had inflicted her wounds.
The Crown Prosecution Service decided that it would not be in the
interests of the public – or the public purse – to pursue this case. The
coroner, aware that a very angry family was sitting in his court, ensured the
police were present for the inquest. Iain did not give his statement in
person, although, of course, there was reference to it. My evidence was
punctuated by angry cries and much scoffing. The coroner more than once
had to call for calm.
My opinion was vindicated when the coroner gave the verdict of
justifiable homicide. It was delivered to a court which, for a moment,
listened in complete silence. And then broke into uproar.
I slipped away as the shouting worsened. So far as I am aware, the
threatened civil action against the wife did not materialize. When I got
home, Chris was out and Anna was bending over her physics books in a
bubble of concentration. She reminded me of Jen. As I carried in the thick
files from the knifing case, I wondered if I had ever pored over my books
with such concentration or if, like Chris, I had been more erratic.
‘What have you been doing today?’ she asked.
I told her about the coroner’s court, the angry relatives. It was the first
time she had ever inquired directly about my job.
To my amazement, she said, ‘Can I see the photos?’
The one thing she did know about my work was that the pictures were
taboo.
‘The photos of …?’
‘The husband’s body.’
She was fifteen and studying for her GCSEs. I shook my head. ‘You’re a
bit young to look at pictures from the mortuary.’
‘No, really, I want to see them. I’ve seen loads of diagrams in biology.’
‘But your biology book diagrams don’t have stab wounds.’
‘I really think I can take it, Dad.’
Maybe she was right. Maybe it was time to stop shielding my children
from the unusual nature of my work. Maybe all those fixed specimens in
my study that were en route to lectures or court (it was scarcely possible to
hide them all), the medical talk at mealtimes, maybe it all meant death was
more routine for her than I’d realized.
I said, ‘I’ll show you the wounds on the wife and we’ll see how you get
on. Since she’s very much alive. And you can tell me if you think she
stabbed herself to make it look as if her husband attacked her.’
Anna’s eyes lit up.
‘I thought she didn’t, the coroner thought she didn’t, but Iain West wrote
a scathing report saying she did.’
Anna nodded enthusiastically.
‘And this is not, I repeat not, to be discussed with anyone outside this
family,’ I added sternly. She gave me a withering look.
‘Duh. I know all that.’
We spent an odd but strangely bonding half hour discussing wounds.
Their ugliness seemed not to bother Anna at all. Finally, at her pleading, I
showed her the pictures of the husband, of the stab wound to the heart that
had killed him. Cleaned up in the mortuary, it looked unspectacular.
‘He’s just like an asleep person,’ she said. ‘Dead bodies aren’t scary
really.’
‘They aren’t scary at all, but I’m not showing you the pictures of his
insides, all the same.’
She shrugged.
‘OK,’ she said, ‘but it wouldn’t bother me.’
It did occur to me, for the first time, that Anna might be discovering her
inner pathologist.
‘I thought you and Chris both wanted to be vets,’ I said.
‘He does. I do. But I might want to be a doctor.’
‘Well, I wouldn’t think of becoming a pathologist, certainly not a forensic
pathologist.’
She blinked at me in surprise. Even I was surprised to hear myself.
‘But Mum says you love your job!’ she protested.
‘I do. But …’ But what? Suddenly the courtroom humiliations, the angry
relatives, the many faces of grief, the healthy old ladies whose deaths no
one had thought suspicious and who had now been disturbed in their
graves: it all seemed like something I wanted my daughter to avoid.
‘Dad?’ She sounded alarmed. ‘What’s up?’
I said, ‘Anna, I’ve just realized something. It’s time I took up flying
again.’
30
The inquiry Stephen Lawrence’s family had fought so hard for was finally
drawing to a close with the century. In his final report, early in 1999, Sir
William Macpherson said, ‘We believe that the immediate impact of the
inquiry … has brought forcibly before the public the justifiable complaints
of Mr and Mrs Lawrence, and the hitherto underplayed dissatisfaction and
unhappiness of minority ethnic communities, both locally and all over the
country, in connection with this and other cases, as to their treatment by
police.’
The police’s investigation into Stephen Lawrence’s death was described
as ‘palpably flawed’ and I believe it was here that the public first
encountered the expression ‘institutional racism’. The inquiry and its
revelations marked a significant change in the public’s attitude to the police:
they were no longer necessarily the trustworthy friends of the innocent.
And, within the Met, perhaps the inquiry also led to the beginning of a
change in attitudes towards minority communities.
For the Lawrence family, it was not all over yet. The rest of their story is
well known: it unfolded over the next thirteen years and perhaps continues
to unfold. At least partly due to this case, in 2005 the double jeopardy law
was revised, with the result that the accused can now sometimes be retried
for the same crime if new evidence has been found.By 2011, scientific
advances had found Stephen’s DNA on the suspects’ clothing and this was
sufficient new evidence to put the suspects on trial again. It was my most
recent, although perhaps not my last, court appearance for this case. In
January 2012, Gary Dobson and David Norris were found guilty of murder
and given life sentences of approximately fourteen years each. Three of
Stephen’s murderers remained at large, at least for that crime. The main
suspects have been openly named many times.
Back to the end of the 1990s, where life at St George’s felt deceptively
stable and life in general was elevated by flight. Because I could now fly
solo. Yes, one cold, clear January day, I went up there. Into the sky.
Completely alone.
I do not know why having nothing but air beneath me, above me, on all
sides of me, offered such a release from my job’s harsh realities. I do not
know why being surrounded by so much space and having the means to
navigate through it gave me an illusion of control over my own destiny that
nothing fixed to the earth could offer. I do not know why sitting at the
controls of a small aircraft simply wiped out the complications that kept my
brain whirring in circles so much of the time. I just know that I loved it, and
all the time I flew I thought about nothing but now, nothing but flying the
plane.
I began to look forward to the time when flying would not be confined to
Friday afternoons with the Met. This year Anna would take GCSEs and
Chris A-levels. Our home lives, and to some extent our working lives, had
always revolved around our children. They didn’t need someone there all
the time now, although they needed support in a different way. But in a few
years, they would both be gone. It was a certainty, a horrible one. We would
have to rethink our world. And acknowledge that a day would come when
our work would be done.
That was why we bought a cottage on the Isle of Man. We had fallen in
love with it one holiday. It was not far from Austin and Maggie’s house and
it would need a lot of work but we had agreed that, eventually, we would
like to live there all the time. Although eventually seemed far, far away.
In 1999 I finally did stop smoking. New millennium, new century, did I
really want to welcome it in through a haze of lung-congesting cigarette
smoke? No, I did not. Did I really want to limit my chances of seeing more
than a few years of the century by consuming industrial quantities of
expensive carcinogens on a daily basis? No, I did not. And, although I had
tried many times before to give up, it was the impending arrival of the year
2000 which meant that this time I was successful. After four or five months
of grumpiness, nicotine gum and jaws like a hamster from chewing it, I
reached a sweet point. I suddenly knew I could live without cigarettes and
that I would go into the new century without ever smoking again. And I
haven’t.
We saw in the New Year on the Isle of Man.
‘I do want to live here,’ said Jen. ‘That’s what I really want for the next
century.’
‘I think I’ll have my pilot’s licence soon. We could live here and just fly
everywhere we need to go,’ I said. Places are always nicer when you fly to
them. But I was in no rush. I wasn’t fifty yet and the Isle of Man was a
retirement sort of place. Wasn’t it?
Chris was planning to start vet’s training in the next year or two. Anna was
studying for A-levels and still agonizing between becoming a vet and a
doctor.
‘Dad, I think it would be a very good idea if I came to a post-mortem,’
she said one day.
Reflex reaction: no.
Anna, so young, so inexperienced, with her smooth cheeks and bright
eyes, should not be confronted by life’s ugly realities in the mortuary, that
was obvious.
‘Chris went! And he wasn’t even sixteen!’
‘Chris was simply shown through the post-mortem room by an idiot
coroner’s officer. And he wasn’t very happy about it.’
‘This would be different, because I’d be prepared. You’d talk me through
it, wouldn’t you?’
No.
‘And when I apply to medical school, think how it would look on my
personal statement. I bet no one else applying will have watched a postmortem.’
No.
So she came with me to a mortuary one day. Not to see a victim of
suicide or homicide but a few sudden, natural deaths. As we leaned over the
body, I glanced up at Anna, her brows knitted with concentration, as I
pointed out that brain haemorrhage, that entirely occluded coronary artery,
that cirrhotic liver, which looked so like a mottled mackerel.
‘If you go into medicine, you don’t have to become a pathologist,’ I
reminded her on the way home. ‘Talk to your mother about dermatology.’
She said, ‘I have. I just wonder if I’m not more of a pathologist, really.’
It was strange to think of the next generation of Shepherds being grownup and out there working. Because that meant the last generation must be
getting old.
I knew this for sure one summer day in 2001 when I found myself
attending the funeral of Iain West. He had died, aged only fifty-seven, of
lung cancer, caused, I can say without doubt, by his smoking – a habit that,
of course, I had shared until recently.
We had known he was dying for a few months, but when I heard the
news, I could hardly believe it. I had seen him not long ago at Westminster
coroner’s court. He had come to give evidence: nothing could keep the old
trooper away. Perhaps he knew it would be the last time he’d take the oath
and hold a court in thrall. Downstairs, in the offices, I thought how much he
had aged and how diminished he looked. He climbed the stairs to the oakpanelled courtroom very slowly – but no one dared to offer assistance. Then
when he rose to give evidence and took the oath, there was a
metamorphosis. The old Iain West was still there. Still in command. Still a
presence.
Now that he was gone I felt keenly that, as well as being my mentor and
teacher, my opponent and rival, he had also been my friend. Those long
conferences in his office and in the pub, the sudden kindnesses, the
knowing but unacknowledged intimacy of colleagues who have worked
closely together for many years – it was no less a friendship for being
office-based. And now my friend simply was not there any more and I had
not made enough effort to see him and enjoy his company during his last
illness and enforced semi-retirement.
As if this was not melancholy enough, there was double devastation
because, on that same day, Jen’s father, the estimable Austin, died on the
Isle of Man, leaving the family heartbroken.
Not one memento mori, but two. You might think that, since we
constantly stare death in the face, pathologists don’t need to be reminded of
our own mortality. We do. We, too, need prompting by the death of those
close to us to get on with the things we want to do in life. For Jen and me,
living on the lovely Isle of Man was one of those things. Now we wondered
if we shouldn’t do it sooner rather than later. We also thought Jen’s mother,
the widowed Maggie, might need us. It was time seriously to recognize that,
if we wanted to live on the island, this was not something we could put off
for ever.
That year, 2001, also saw the release of the final reports on the
Marchioness disaster. Lord Justice Clarke held both a formal inquiry into
the disaster itself and a non-statutory inquiry (which is more flexible and
generally regarded as less ‘clunking’ in its approach) into the handling of
the Marchioness dead and their relatives. After the formal inquiry, there
were still more recommendations for the improvement of safety and
lifeguarding systems on the Thames. And, at the non-statutory inquiry, Lord
Justice Clarke confirmed that the Marchioness relatives were the victims of
a human and systems failure. His report recognized the muddles in
management and identification procedures: he noted confusions between
key figures who were on holiday and their deputies, between the many
ranks of police officers, between police, coroner and fingerprint officers,
between coroner’s officers, between the mortuary staff and the undertakers.
As for me, the inquiry closed a chapter of my life. The pathologists were
at last exonerated of any blame for the errors that had been made. Eleven
years after the disaster I was finally free of the fury the identification
problems, particularly the missing hands, had generated. The angry phone
calls and press disdain that had reappeared periodically in my life for so
long, stopped overnight.
The non-statutory inquiry report’s wider interest was its many
recommendations for the treatment of relatives and the identification of
victims in a disaster. It happened that for a few years now I had myself been
giving quite a bit of thought to this problem. During the 1990s I had been
asking myself how well we – forensic pathologists and crisis teams in
general – would cope in London with a mass disaster. Because disasters
were changing.
By 2001 our transport systems and cities were much safer than in the past.
The greatest threat now was terrorism. IRA bombings of the 1970s and 80s
and into the 90s were still in our consciousness. And other cities had
suffered. In 1993 a bomb exploded at the World Trade Center in New York,
killing six people and injuring over a hundred. In 1995 cultists gassed the
Tokyo subway with Sarin.
The coroner for West London, Alison Thompson, shared my concern
about planning – or rather the lack of it – for both natural and unnatural
disasters. Her jurisdiction covered the Fulham mortuary where St George’s
pathologists worked but, more significantly, Heathrow airport. In the event
of a mass disaster in London there was an existing understanding that
bodies would be brought to a special hangar at the airport. We decided to go
and have a look at it. And found something that was more like a large
garage. It was full of runway snowploughs and ancillary equipment.
It would have been hard to find a site less suitable. Apart from the fact
that it was dirty and oily and full of heavy plant, access was difficult and
there was only one small hand basin. We proposed to the police, the other
emergency services, local authorities and the supporting charities that we
should all review London’s plans for a large-scale emergency. It turned out
that we weren’t alone in worrying about how the capital would cope in such
an event and everyone was keen to participate.
We knew how to define an emergency. Dr David Paul, the retired coroner
for North London, had once done so very simply, saying, ‘My idea of an
emergency is having at least one more body than my mortuary can
manage.’
Our group met regularly at Heathrow Police Station and the first thing we
did was try to anticipate what sort of emergencies might occur. We
frequently sat around tables drinking coffee and discussing how to deal with
a flu pandemic. Or a big plane crash in the city. Or a terrorist attack. But we
knew that, no matter how bizarre and outrageous our thoughts, the reality
would always be different and that we needed to think and plan from the
specific to the general.
And we were proved correct. Chris was just about to leave home. His
bags were packed and he was soon to catch a train north to study veterinary
science when he phoned me.
‘Anna and I are watching it on TV …’
‘Watching what?’
‘Dad, are you on call for international emergencies?’
That day was 11 September 2001.
I switched on the TV and stared at footage of American Airlines Flight
11 hitting the North Tower of the World Trade Center. This at first looked
like the kind of terrible accident our group had talked about. But when
United Airlines Flight 175 hit the South Tower shortly afterwards, I realized
that, although we had discussed both acts of terrorism and city plane
crashes, it had never occurred to us that the two would be combined in such
a deadly way.
Then, incredibly, impossibly, as the world watched, the Twin Towers
actually fell. First the South. And then the North. And now it seemed to me
that these terrorists had taken disaster to a level that was far, far beyond
anything we could have dreamed of.
I was as appalled and mesmerized as the rest of the world by this
spectacular coup. The possibility of my own involvement did not occur to
me. I assumed my colleagues in America would get on with the massive job
of saving the wounded and finding and identifying the dead: what was there
for the British to contribute? But Alison Thompson was soon on the phone.
As the coroner for West London, Alison would be receiving any
repatriated British bodies at Heathrow and it would be her job to establish a
cause of death. Any British citizen who dies abroad is entitled to an inquest
in the UK by law: this has been the case since 1982, when the father of a
young British nurse who died in sleazy circumstances in Saudi Arabia
refused to accept the official cause given for her death, and the consequent
change in the law has resonated through the decades.
Alison was also well aware that, when a civilian plane had been downed
by a terrorist bomb over Lockerbie in Scotland more than ten years earlier,
a number of mistakes had been made in the management, not least the
identification, of just a few of the bodies. But ‘a few’ mistakes in this
critical situation has the effect of destabilizing and distressing a huge
number of families.
Alison’s concerns about the management of the British fatalities resulted
in the rapid formation of a group at Scotland Yard consisting not only of the
police and emergency services members of our existing mass disaster
committee, but also many more high-ranking officials.
The questions we asked were: What support can we offer the New York
operation? How should we repatriate our dead? Should we carry out our
own post-mortems on the British fatalities back here in the UK? Would the
families find acceptable that further interference with the bodies of their
loved ones? Or should we leave all post-mortems and identifications to the
Office of the Chief Medical Examiner (OCME) of New York? If we
repatriated the bodies, they could be distributed around the country to their
own local coroners, in which case should each local coroner hold an inquest
and reach his or her own verdict? We could imagine inquests going on for
months or even years and there would probably, certainly, be a huge range
of different and maybe conflicting verdicts, ranging from accidental death
to homicide to unlawful killing.
We agreed we should assess what OCME in New York was doing first.
We could then determine a formal UK response and offer appropriate help.
We reported directly to the prime minister, Tony Blair, at the Cabinet
Office’s central emergency co-ordinating group, COBRA. They decided we
needed some first-hand opinions and so it was finally determined that on 20
September – the day on which I became forty-nine years old – I would fly
out to New York to see how the Americans at the Office of the Chief
Medical Examiner were handling things. I phoned my colleague at OCME,
Yvonne Milewski, and arranged to meet her on my arrival. She sounded
tired and emotionally drained. But welcoming all the same.
I landed in a New York that was strangely quiet, even for the middle of
the night. The city was still hushed with horror. Nine days after the towers
had collapsed, the event’s dust and smell still hung in the air. And although
roads were blocked and tunnels were closed, when the traffic stood still not
one horn honked. I told the taxi driver where I was staying and he said there
were at least four hotels of that name. So we drove through quiet streets
trying them all. Eventually we knew we’d found the right one because the
lobby was full of British police officers, some of whom I recognized. They
gave me a warm welcome and asked me if I fancied a drink, but I had to
decline. I’d arranged to meet Yvonne at the OCME mortuary and was
taking a cab straight there.
I arrived at 2.30 in the morning to an unforgettable sight. The building
itself was an ugly 1960s concrete pill box, but the building was not the
focus of attention. The surrounding streets and parking lots had been
partitioned off and were fully guarded because here was the twenty-fourhour receiving area. Once through security I was into a makeshift, floodlit
resting plaza, full of tented cafes and workers taking a break over coffee
and doughnuts. Beyond were huge, refrigerated trailers, at least thirty of
them, lined up neatly in adjacent tented parking lots, flowers guarding the
entrances, American flags standing sadly sentinel.
I sniffed. That aroma. It was obvious the trailers were full of human body
parts.
Even at this time of night, an occasional hearse reversed into the docking
bay with a body bag on board. The search crews at Ground Zero were
working around the clock and the pathologists were working too: Yvonne
had volunteered for the night shift. And the day shift. She just grabbed sleep
when she could.
You needed huge resilience to cope in this bizarre and disturbing
environment. Many people found that they didn’t actually have that
resilience and the mental trauma to the rescue workers and to the mortuary
staff was huge. Some coped. Some were sent home, looking like people
with shellshock.
The shift pattern meant that there was never a delay in the start of the
formal examination and identification process. Some of the body bags were
known to contain a member of the police or fire service who had risked –
and lost – his or her life in the carnage. For these Members of Service, a
colour party formed which formally saluted their bravery as they were
carried in to OCME.
Inside the many body bags were whole, or almost whole, bodies. Smaller
body parts sometimes came in smaller boxes. The basic rule of all disaster
recovery sites is that if a rescue worker finds, say, a finger, even if it seems
quite clear which body that finger belongs to, it must be catalogued
separately and given a unique number. The nature of this disaster, the huge
forces from the impacts and from the collapses, meant that the bodies were
frequently so fragmented that you simply couldn’t put people together by
sight, guided by their location or clothes. It was clear, very early on, that
many or maybe most of the identifications would have to rely on DNA.
Later, sometimes much later, based on this amazing technique, limbs,
portions, parts, pieces and fragments of tissue would come together to
reform something like a body, or what remained of it. As in all mass
disasters, identification of the victims was to be a huge administrative as
well as scientific operation. It was just that in this disaster the task was in
every way bigger, worse and harder than anything experienced before.
As they arrived, bodies were taken into the primary receiving room
where preliminary examinations were performed. And then they were taken
directly to one of the examination suites. Each suite had a full team of
police, pathologists, photographers, radiologists and assistants. Postmortems were carried out in the usual way, on whole bodies or parts of
bodies. Extensive details were recorded and these findings were linked with
the fragments of clothing, personal artefacts – jewellery, credit cards, etc. –
and any other features and details of where exactly the body had been
found. Then, carefully numbered, the body or body part was taken to its
unique place on a uniquely numbered shelf inside a uniquely numbered
trailer.
The bodies were treated with great respect and the trailers were kept
clean and well ordered, the Stars and Stripes a reminder of the state and the
containers of flowers a reminder of the people. The trailers solved the key
problem of any such disaster: not so much processing the dead as storing
them until the identification can be made. After that, they can be released to
the families. It was clear to me that the Americans were doing a fantastic
job of looking after things, methodically and respectfully.
I tried to remain as unobtrusive as possible, since everyone on site was
working hard. The same was true when I returned the next day to meet the
chief medical examiner himself, Charles Hirsch. He was a small, slight and
distinctly stressed man in his mid-sixties who was running this massive
operation with stitches across his head and some fractured ribs. He had been
among the early rescue workers who arrived at the World Trade Center just
before the first of the towers fell. How had he escaped with comparatively
minor injuries when the colleagues who had been standing next to him were
felled by rubble and were now in intensive care?
The trailers were filling fast. Eventually it was concluded that there were
2,753 victims, and in total something like 70,000 body parts or fragments
were found. Many of the bodies had been pulverized, either by the initial
explosion or when the buildings came down. It would have been a lot easier
to have put everything into one mass grave but, of course, the families of
the dead could not bear the idea that their loved ones might be buried with
the hijackers.
Soon, all the rubble from the World Trade Center was being shifted to an
old landfill site on Staten Island in the Hudson Bay Estuary, strangely called
Fresh Kills. It was sifted, every bit of it, not once but twice by a skilled
team led by police and the FBI, which included anthropologists and doctors.
And then the long journey through the DNA of almost 3,000 people began.
Each tiny fragment of human tissue, each personal effect had to be
identified.
This programme in fact continued for many years: identifications were
still being made in 2013. Finally, in 2015, 1,637 victims had been
identified, accounting for just 60 per cent of those believed to have died: the
others had become dust, as all bodies must. Now there are plans to turn
Fresh Kills into one of the world’s largest urban parks.
An anthropologist friend who worked sifting through the debris was, like
many others involved in the disaster, traumatized by it. After months of
sieving for bits of human tissue and bone she developed a horror of flying.
When she returned to the UK, before boarding her flight she wrote her
name on every part of her body, every single limb, in case the plane crashed
and she was dismembered. In fact, it was many years before she worked
again.
Towards the end of my brief trip, I was driven to a nondescript building
in Manhattan that was one of the British Consulate offices in New York. A
Foreign Office team from the UK was waiting for me. At that time, we
knew there were many British dead but not how many.
‘So,’ demanded one of the officials, ‘how are we going to get our British
bodies home?’
I wondered how they imagined the repatriation of the bodies to be. Then
one of them, a politician, talked about a row of coffins being driven in slow
convoy from the airport to London, each draped in the British flag.
I shook my head. I had been up for almost two days and I was shocked
and tired. From the coalface, this line of flag-decked hearses sounded like a
politically motivated stunt to maximize the drama and photo opportunity for
the government. I felt something dangerous rising inside me, something
really terrifying, something that, if I had let it, could have turned into fury.
And I am never angry, let alone furious. But now something escaped.
‘Coffins? Did you say coffins? Most of these people have been
pulverized, don’t you understand that? Instead of coffins you’ll probably be
sending them back in matchboxes!’
They glared back at me. There was little further dialogue. I was thanked
and dismissed.
My report praised the Americans’ handling of the disaster, saying that we
could use their paperwork instead of creating our own. As a result, although
the final death toll for Britain was, in fact, sixty-seven, just one coroner’s
court in the UK, run by an experienced and empathic coroner, dealt with
every British fatality. Just one American police officer flew over to give
evidence. And there was just one verdict. It was unlawful killing.
Four years later, London too came under Islamist attack. On 7 July 2005,
fifty-two people were killed and more than 700 injured when four terrorist
bombs exploded, three of them on the London Underground and one on a
bus. Literally a few days earlier, with the involvement now of many
agencies, the mass-disaster plan that the coroner Alison Thompson and I
had started thinking about back in the 1990s had been signed off.
I was not in London at the time but when the appeal went up for help I
flew straight back and set to work in the excellent, tented temporary
mortuary facility that had been constructed in less than forty-eight hours on
the playing field at the Honourable Artillery Company in the City. All the
bodies were taken here and the facility, indeed our whole plan, proved fully
functional. I carried out my work with immense sorrow. Perhaps, deep
down, in some irrational place, I might have hoped that, by making a plan,
we would be saved from ever putting it into action. What wishful thinking.
The coroners in charge of that crisis may have had one regret. Relatives
of Marchioness victims had bitterly criticized the need for the full postmortems we had carried out, saying they were unnecessary since the cause
of death after such a disaster was clear. Consequently, after the 2005
bombings we were told not to carry out full post-mortems. Our job was
identification only. If we opened bodies, it was purely to look for the gall
bladder and appendix because if they had been removed this might assist
identification.
Afterwards, extraordinarily, the ambulance service was criticized for
being too slow in recovering the wounded. Crews do not go where they
may be harmed and, because there was a risk that further bombs had been
planted, they had been told to wait before entering the bomb sites.
Accusations followed that this delay had actually been responsible for a
number of deaths. There was a suggestion that lawyers for some victims’
families would seek compensation from the emergency services. Because
full post-mortems had not been carried out, we pathologists struggled to
answer the questions asked by both families and the coroner to resolve
these claims.
I did learn from this. Years later, I was the pathologist in charge when
taxi driver Derrick Bird went on a killing spree in Cumbria. It was highly
reminiscent of Michael Ryan’s massacre in Hungerford more than twenty
years earlier. Some people pressed me not to perform full post-mortems on
the grounds that it was obvious what the cause of death was. Mindful of
7/7, I did not give in to their entreaties. Every patient first had an MRI scan
to reveal the position of every bullet, and each body was given a full postmortem. There was not one criticism of the emergency services’ response.
31
My second brush with the work of Osama Bin Laden was in Bali a year
after 9/11. Two bombs planted by Islamic extremists connected to Bin
Laden exploded in crowded tourist areas of this lovely Indonesian island
and more than 200 were killed, most of them Western holidaymakers and
most of them under thirty.
Once again, at a few hours’ notice I found myself on a plane. I was
sitting next to some rather bulky men. I thought possibly they were from
special forces. In fact, we didn’t speak the whole way, although I guessed
that we were all flying east for the same reason. I assumed they thought I
was a tourist or a reporter. However, when there was no one to meet me at
Denpasar Airport, they noticed this and turned to me by the luggage
carousel for the first time.
‘Want a lift, Doc?’
‘How did you know who I am?’
‘We guessed you must be the pathologist just by looking at you.’
‘How?’
‘Well, for a start you didn’t laugh at the movie.’
That’s pathologists for you. Miserable, death-obsessed, dour-faced
butchers. But I was grateful for the lift. And the first person I saw at the
hotel was coroner Alison Thompson, who happened to have been staying in
Hong Kong and had flown directly here, knowing, again, that the British
bodies would fall under her jurisdiction when they arrived at Heathrow. We
greeted each other warmly and, although it was early morning in Bali,
decided to set off for the hospital where the bodies were being stored.
Before leaving London, I had been told that I was simply viewing the
operation from the British point of view. But when I walked into the
mortuary the other pathologists (mostly Australians but also Dutch and
Germans) recognized me from international meetings we’d all attended and
immediately handed me a gown, an apron, some rubber gloves and a knife.
And said, ‘Get on with it, Dick.’
The British embassy staff had done an amazing job of locating the British
bodies. Not only that, they had found the fuel to keep the generator going of
one of the few chilled containers in the whole place – if not the whole
country. In fact, as with all disasters, we pathologists just worked a
conveyor-belt system of post-mortems, taking whichever body came next,
whatever the nationality.
The problem was lack of facilities for the dead in a world of intense heat.
I will never forget the sight or the smell of the bodies laid out in the shade,
covered with bags of ice cubes from the supermarket. How I longed to find
a lorry full of ice which we could tip all over them. They were changing
fast, and not for the better. Many were already fragmented and
identification was the usual jigsaw challenge, only made more complex by
the untrained recovery teams who just threw everything they found in one
area into one bag. It was a great relief to come across an isolated hand
wearing a wedding ring which was engraved on the inside with the name of
its bearer. It was a small, tragic item and it gave us one small piece of the
tragic puzzle.
Most of the victims who had been attracted to that sybaritic island were
young and beautiful. They had been enjoying themselves in the bar or
nightclub where the two bombs exploded, one after the other. The bombs
were planted by an extremist group believed to be funded by al-Qaeda.
Eventually it was confirmed that there were twenty-eight British fatalities
and that overall more than 200 people were injured and 202 were killed. It
was a hard, exhausting and traumatic time. I have subsequently visited the
memorials to this atrocity both in London and in Perth, Western Australia,
but no memorial is necessary to remind me of the decaying bodies, the ice,
the smell, the single dripping tap in the mortuary that was our water supply
and the overarching sense of the futility of terrorism. I am not sure it has
ever really left me.
Back home, my working life was feeling insecure. The world of forensic
pathology was changing and we were now threatened by new uncertainties
of a sort the great Simpson never had to face. The university medical
schools had always paid us to lecture in our subject but they decided –
almost all of them, one by one – that now they would not continue funding
or teaching forensic pathology. The main reason they gave was lack of
forensic research and lack of publication in prestigious scientific journals.
However, we were too busy with post-mortems and coroners and courts to
meet these new benchmarks of a Good University. The age of intellectual
evaluation through research assessment exercise had arrived. And we
forensic pathologists were found wanting.
Gradually, medical schools with great traditions of forensic pathology
closed down departments and it wasn’t long after Iain West’s death that his
kingdom at Guy’s disappeared. St George’s hung on a bit longer, but my
new department’s warrant for execution had been signed.
We had essentially been privatized. From now on, instead of providing
forensic services for free, our salaries paid by the universities at which we
taught, we would directly bill the police, coroners or defence solicitors for
payment.
I knew that, without a salary, it would be hard to continue with some
necessary but unpaid work. I am talking about public work, like my
ongoing contribution to teaching the authorities safe restraint methods. And
my participation in disaster planning. Everyone else at the group was
salaried by the police or some other organization: I no longer had the
weight of a university behind me.
Not only was the regular income gone, so were lectures and so were
students, except at just a few specialist centres outside London. I had only
ever lectured to packed halls and knew how interesting medical students
found forensic work. I also felt that at least the rudiments of forensic
medicine should be an important part of their training. Every doctor, no
matter what their discipline, should be able to identify the signs of
suspicious circumstances so that they would know when to call an expert or
the police. But there was too much ‘real’ medicine competing for too little
space in the training schedules and forensic pathology now became
accessible only on specialist postgraduate courses at few universities.
I set up a group called Forensic Pathology Services, widely known as
FPS, through which pathologists in London and the south-east of the UK
would operate in our brave new privatized world. And suddenly, while I
was buried deep in its planning and organization, I realized that I might not
want to be a part of it.
With a heavy heart, I had dropped Anna off that autumn at university: she
had finally decided to study medicine. So they were gone now, both of our
children, to the north of England. Of course, they still needed us, but not in
the same way. Our house seemed large and empty and quiet. Was that why
we were spending more and more time on the Isle of Man? That home was
nearer the children than London. Was it because, as my lectureship duties at
St George’s were being wound down, there was little to keep us here? Was
it because we loved our cottage on the island and wanted to support Jen’s
now-widowed mother – not that Maggie had let widowhood stand in the
way of her social life – and in fact were now ourselves becoming part of her
whirl?
Or … was my work in London beginning to weary me? Weary me so
much that even flying on Friday afternoons could not restore me? Every
court appearance seemed to turn into a bruising scrap and sometimes I felt I
lacked the resilience to cope with it. There was no longer a bounce in my
step when the police called me to another crime, another body. I had given
up hope that they would ever phone me for my opinion on a case. And,
looking into the future, I could see that pathologists eventually could be
tendering for contracts, competing for bodies, even undercutting each other
on price. Forensic pathology was a service, but no longer the intellectually
rigorous world I had entered, with its scope for debate, study and social
change.
Jen had become disillusioned with her work, too. Despite her amazing
feat in becoming a doctor so late in life, once she was practising as a GP she
found she did not really want to be one. She had always been keen for us to
move to the Isle of Man and believed that here she could practise her own
specialization, dermatology, and live in the place she wanted to be.
What else pushed us there? Our knowledge of our own senescence? A
longing for the lifestyle Maggie and Austin had enjoyed? A hope that, if we
spent more time isolated together on an island, somehow the loving
communication which was missing would suddenly reappear?
Perhaps I – and perhaps Jen too – was having that thing people call a
mid-life crisis, which no pathologist has ever been able to locate within the
human body, not even under a microscope. But when I was asked to write
the twelfth edition of Simpson’s Forensic Medicine (the third edition of
which you may remember had lured me into this profession), the invitation
felt like a huge honour. And an excuse. So I was midwife to, but did not
remain with, the new Forensic Pathology Services. Instead, Jen and I left
London for good. We gave up the tidy hedges and neatly mown lawns of
Surrey for a windswept and beautiful cottage on an island somewhere off
Liverpool. I was generally believed, by my colleagues and contemporaries,
to have completely lost my marbles.
I was very happy and busy renovating the cottage. We went walking for
miles over wild and windy moorland under big, big skies that were
sometimes so clear we could see across the water to where the Mountains of
Mourne sweep down to the sea. We sat by the fire while gales whistled
outside. Or we just stared across the fields to the ocean as it conjured up
dramatic storms from its depths. I did not carry out a single post-mortem.
And, here we had a social life. We had always been too busy for this
before but now we had friends. It mattered little that we were much younger
than most of them. We simply slotted into the society that had been readymade for us by Maggie. So what if she was ageing a little now? She was
still at every party, a woman with haute couture dresses bulging from every
wardrobe in almost every bedroom in the house. Something delicious
bubbling on the stove, a gin and tonic always at the ready and she was
never without an admiring circle of friends. It felt good to be among them,
good to be part of a community. The children visited often.
For me there may have been no more post-mortems, but there was lots of
interesting work. I was writing my textbook on forensic pathology. I flew
myself to the mainland to sit on committees for the British Association of
Forensic Medicine, who were still sorting out Home Office contracts and
many other details of the new privatized landscape. I was asked to give
opinions on complex cases. I was busy on several ministerial working
groups, devising and promoting more humane methods of restraint.
Of course, I kept an eye on all interesting developments in my field. I
learned that the police had reopened the inquiry into Rachel Nickell’s
murder: they now, finally, began to accept that someone other than Colin
Stagg might have killed her. It took another six years for developments in
DNA testing to nail Robert Napper for her death, the man who had
murdered Samantha Bisset so violently and who was already detained in
Broadmoor for life. I recalled carrying out the second post-mortem on
Samantha Bisset’s mutilated body and I remembered saying to the detective
how much I was reminded of Rachel Nickell’s murder. I wished now that I
hadn’t simply made a passing remark but said something more forceful,
more questioning, more insistent.
There was also a major development in the case of Sally Clark, the
mother convicted of killing her two baby sons. She seemed to be planning a
second appeal. She had been in jail for over two years now, but this appeal
would be based on new evidence. New pathological evidence.
The results of tests performed on blood and tissue samples taken from
her second child had been discovered. The pathologist had not revealed this
evidence before. In the view of some experts, but certainly not all, it
showed that the second child might have died naturally of a bacterial
(staphylococcal) infection.
The Court of Appeal’s job was to assess whether, if the jury had been in
possession of this information at the time of the trial, it might reasonably
have affected their decision to convict. The three judges decided that it
might, and that therefore the conviction was unsafe.
In 2003 Sally Clark, by that time a broken alcoholic, was released from
jail. She died four years later.
Sir Roy Meadow, the man who produced the extraordinary statistic that
there was a 1 in 73 million chance of two children from the same family
dying naturally, was publicly discredited. A number of the other mothers he
had given evidence against and who were serving sentences now launched
successful appeals. His maths was challenged by statisticians and he was
struck off by the General Medical Council. He later, much later, won his
appeal against being struck off, but by then he was over seventy. One piece
of bad, off-the-cuff, maths in court under intense cross-examination was a
sad ending to a previously highly distinguished career.
The pathologist, he who had examined both babies, changed his cause of
death in one of them and apparently withheld test results, was found guilty
by the GMC of serious misconduct. He was suspended from carrying out
Home Office post-mortems for eighteen months.
David Southall had been a commentator on, rather than a direct
participant in, the Clark brothers’ case but Sally Clark’s release now
catalysed the inevitable backlash against his views and against the growing
child protection movement. He may have furthered our understanding of the
medical and moral complexities of infant mortality in general, and SIDS in
particular, but angry pressure groups were formed by parents under
suspicion and others who sympathized with them. (And don’t we all
sympathize with the outrage of those who claim to have been unjustly
accused?)
The groups complained to the GMC about Professor Southall. The GMC
took their protests to its Medical Practitioners’ Tribunal Service. He was
judged unfit to practise and struck off. It took him many years and a Court
of Appeal decision to overturn this verdict. His condemnation by the GMC
received wide coverage: his subsequent complete exoneration went almost
unreported.
The Sally Clark case perhaps charts the history of our relationship with
SIDS. Fashions in thinking should have no place in the world of scientific
truth, but they certainly do. Ten years earlier she would have been regarded
as simply a tragic figure for losing two babies. By the time her first son
died, SIDS was declining but still a widely given cause of death. By the
time her second son died, thinking had progressed further and any
pathologist in the land would take into account the full circumstances of the
case. The cause of death actually given was that the baby had been shaken,
and this reflected the topicality of shaken baby syndrome at that time.
Overall, the case revealed our deep new suspicion of mothers when their
babies died suddenly. Her successful appeal may have reflected a public
reconsideration of that level of suspicion.
In fact, although the pathologist involved certainly made errors of
recording and disclosure, the medical evidence was extremely complex and
controversial and huge numbers of experts lined up to disagree with each
other in court on almost every aspect of both children’s deaths. The truth in
the Clark case, as in so many, proved to be not solid but a rather
unpredictable liquid. The courts wanted honesty and truth and then chose to
be selective and make their own assessments of highly complex medical
issues.
No one emerged unscathed from the tragedy of the Clark case. For
forensic pathologists, it was certainly a horrible reminder of the huge
responsibilities of our profession.
32
Much as I loved life on the Isle of Man, after a couple of years I began to
miss the cut and thrust of day-to-day forensic pathology. I missed the
camaraderie in the mortuary and at crime scenes, the sense of a close-knit
team working together. I recalled the great humanity of all involved, while
the startling evidence of cruel, murderous inhumanity lay before us.
Committee work began to fill that gap. In particular, I was involved in
producing guidelines to help the police and other authorities deal with a
new challenge which was caused by the growing use of crack-cocaine. This
drug can produce an extraordinary mental state in some users which makes
them as strong as an ox and twice as dangerous. How to restrain these
powerful, dangerous people to safeguard the public – without actually
killing them? Helping to solve this problem was worthwhile, good work,
but it was not like solving a problem at the mortuary. Now, I always seemed
to be once removed from the body, from the scene of the crime, from the
coalface.
Then, in 2004 I became engrossed in one of the most interesting and
high-profile public inquiries underway at that time. It arose from events
seven years earlier and many miles away.
I had not been the Home Office pathologist on call on the weekend of 31
August 1997: that fell to my colleague at St George’s, Rob Chapman. In the
early hours of that morning, the Princess of Wales and Dodi al-Fayed died
in a road traffic accident in a Paris tunnel, he at the scene and she in
hospital after an operation. The bodies were flown into RAF Northolt the
same day and the then coroner for West London, John Burton, who by
chance also happened to be the coroner for the Royal Household, assumed
responsibility for them. That evening, surrounded by high-level police
officers, evidence officers, a crime-scene manager, the coroner, Met police
photographers and mortuary assistants, and with still more officers holding
back the public outside, Rob carried out the post-mortems in Fulham. Both
had died from injuries sustained in the accident.
The questions over those two deaths have never gone away. In a bid to
stem the inevitable tide of conspiracy theories, a police inquiry was opened
in 2004. It was led by Sir John Stevens, then commissioner of the
Metropolitan Police, later Lord Stevens, and its aim was to establish
whether or not there were grounds for treating the deaths as anything other
than a road traffic accident. The new coroner to the Royal Household,
Michael Burgess, suggested I act as forensic pathologist to this inquiry. Of
course, both bodies had been long buried, and so it was my job to review
the evidence my colleagues had produced in 1997.
There has famously been much speculation about the cause of the
accident, but I don’t think there is any doubt about the fact that Dodi and
Diana left the back door of the Ritz in the hotel’s Mercedes driven by Henri
Paul and, crossing Paris at speed, pursued by photographers, their car hit the
thirteenth concrete pillar in the Alma Tunnel at over 60mph.
If a car comes to a dead stop after such an impact, unless restrained by
seat belts, the bodies of the people in the car don’t stop with the vehicle.
They continue forward and hit the windscreen, the dashboard or the people
in front of them. Diana and Dodi, in the back seats, were not wearing seat
belts. Nor was the driver. He hit the steering wheel and his injuries reflected
that but, microseconds later, he was also hit from behind by Dodi, who was
a big man and who was still travelling at over 60mph. Henri Paul
effectively acted as Dodi’s airbag and he died instantly. So did Dodi.
Diana was slightly more fortunate because the al-Fayeds’ bodyguard,
Trevor Rees-Jones, was sitting on the right of the driver, in front of her.
Bodyguards don’t usually wear seat belts as they restrict movement, but
evidently Rees-Jones, maybe because he was alarmed by Henri Paul’s
driving or maybe because he realized an impact was likely, put on his belt at
the last minute. Belts are designed to give gradually while they restrain. So
he was held by the belt and partially padded by the car’s airbag, which by
now had inflated, as Diana’s body catapulted forward from the back seat.
She was much lighter than Dodi and Rees-Jones’s belt would have absorbed
some of the extra force. This slightly lessened the energy of the impact for
her and so, more protected than Dodi, she actually suffered just a few
broken bones and a small chest injury.
Since Dodi al-Fayed and Henri Paul were clearly dead when the
ambulance arrived, the paramedics rightly turned to the injured. They did
not recognize Diana, who is reported to have been talking. Trevor ReesJones had taken the double whammy of his own weight forcing him
forward and Diana’s weight hitting him from behind and he seemed much
more seriously hurt. Of course, he was therefore taken out first. Diana was
anyway effectively trapped behind the front passenger seat until he was
removed.
Rees-Jones, as the more seriously injured party, was put in the first
ambulance. Diana was then extracted from the car and taken to hospital as
an emergency. No one knew that she had a tiny tear in a vein in one of her
lungs. Anatomically, this site is hidden away, deep in the centre of the chest.
Veins, of course, are not subject to the same high-pressure pumping as
arteries. They bleed much more slowly, in fact they bleed so slowly that
identifying the problem is hard enough and, if it is identified, repairing it is
even harder.
To the ambulance services, she initially seemed injured but stable,
particularly as she was able to communicate. While everyone focused on
Rees-Jones, however, the vein was slowly bleeding into her chest. In the
ambulance, she gradually lost consciousness. When she suffered a cardiac
arrest, every effort was made to resuscitate her and in hospital she went into
surgery, where they did identify the problem and attempted to repair the
vein. But, sadly, by then it was too late. Her initial period of consciousness
and initial survival after the accident is characteristic of a tear to a vital
vein. Her specific injury is so rare that in my entire career I don’t believe
I’ve seen another. Diana’s was a very small injury – but in the wrong place.
Her death is a classic example of the way we say, after almost every
death: if only. If only she had hit the seat at a slightly different angle. If only
she had been thrown forward 10mph more slowly. If only she had been put
in an ambulance immediately. But the biggest if only, in Diana’s case, was
within her own control. If only she had been wearing a seat belt. Had she
been restrained, she would probably have appeared in public two days later
with a black eye, perhaps a bit breathless from the fractured ribs and with a
broken arm in a sling.
The pathology of her death is, I believe, indisputable. But around that
tiny, fatal tear in a pulmonary vein are woven many other facts, some of
which are sufficiently opaque to allow a multitude of theories to blossom.
The conspiracy theorists, particularly Dodi’s father, Mohammed alFayed, believe the crash was no accident but had been arranged. The most
widely held proposition is that the couple were killed because Diana was
about to embarrass the British establishment by announcing a pregnancy.
Since I did not carry out her post-mortem myself, I cannot categorically say
that she was not pregnant. Rob Chapman has been examined and crossexamined on this point and he has explained that there was no indication of
pregnancy: bodily changes would have been detectable perhaps two but
certainly three weeks after conception, even before she herself would have
been aware of pregnancy.
Some people have asked me whether Rob could have been persuaded to
lie. The answer is an emphatic ‘no’. He would never dispense with the
engrained methods of a lifetime and agree to obscure the truth from a postmortem (and neither, for that matter, would I).
The conspiracy theories, however, did not rest entirely on Diana’s alleged
pregnancy. Any number of reasons have been proposed to explain why the
car crashed that night and the theories have been fuelled by the various
anomalies of the case.
First, there was the presence of a second car, a white Fiat Uno, which
appears to have collided initially with the Ritz’s Mercedes before the
Mercedes hit the pillar. However, no one has ever discovered what
happened because neither the car nor its driver – despite extensive searches
throughout France and Europe – has ever been found.
Then there is the anomaly concerning the chauffeur, Henri Paul. His
blood samples revealed him to be drunk, but this was hotly disputed by his
family and by some of those who were with him shortly before the crash.
There were accusations that someone else’s blood had replaced Paul’s,
partly because his sample contained traces of a drug used to treat intestinal
worms in children. Paul had neither worms nor children. However, the drug
is also commonly used to ‘cut’ cocaine – although Paul had clearly taken no
cocaine, at least not that night or even for a few days earlier. In addition,
carbon monoxide levels were exceptionally, although not lethally, high in
Paul’s blood, and no one could satisfactorily explain that either.
Rather unusually, Diana’s body had been embalmed. A French
undertaker arrived at the hospital to do this and no one has ever really
explained why he was called or by whom: certainly not by the pathologist at
the hospital in Paris. Probably the explanation is that embalming is a usual
procedure for a member of the royal family, but since the bodies were flown
immediately back to the UK and Rob carried out post-mortems within
twenty-four hours of their deaths, there was no real need for the French to
introduce preservation fluids into Diana’s body. By doing so, they
compromised all toxicology results. Some people saw this as suspicious
action, but since neither Diana nor Dodi was driving it is very hard to see
what significance any toxicology from them would have had.
After a lot of diplomatic wrangling and armed with many questions we,
the police team and I, went to Paris. The French authorities did not greet us
warmly, or even very helpfully but we saw the crash site and eventually
even the car itself. Other specialists were trying to explain the carbon
monoxide in Paul’s blood and they immediately began to examine the
airbag but my role, of course, took me to the mortuary.
Here I met Professor Dominique Lecomte, the charming pathologist who
had the misfortune to be on duty that night. She had carried out the postmortem on Henri Paul. She spoke good English until I started to discuss the
post-mortem and whether possible lapses in recording systems meant the
blood samples could have belonged to anyone other than Henri Paul. At that
point, she said little more and insisted on speaking only through an
interpreter, and often looked for advice to the lawyer who sat next to her.
I hope she understood how much I sympathized and empathized with her.
A routine Saturday night in a big-city mortuary includes the odd road traffic
accident, unlucky drunks, the victims of crime and brawls. In Paris,
pathologists do not routinely deal with these over the weekend; they start
performing their post-mortems on Monday morning. Professor Lecomte
was therefore asleep at home in the middle of the night when she was
dragged off into a situation of sudden and immense pressure. The world’s
most photographed face had died in a car crash and her driver and boyfriend
had also arrived at the mortuary. Outside, governments, family and the
international press were howling for the professor’s conclusions.
The general rule when presented with a high-profile death is to stop. Do
everything slowly. Carry out all procedures correctly and in strict sequence.
It is worth following these rules because a celebrity death means that your
every action will be questioned for a long time afterwards in public and in
private. During the event itself, you are under pressure to get things done
right now. In half the usual time and with half the usual information. To
give simple answers immediately to complex medical questions. I have
learned the hard way that no one says thank you in these cases. Ever. The
only comments that are made are critical – you either did something you
shouldn’t have done or (more commonly) you failed to do something that,
in retrospect, you possibly should have done.
Unfortunately, pathologists in this situation sometimes do bow to the
immense pressure placed on them to hurry, to cut corners, to accept ‘the
obvious’. They do things out of sequence and may behave in an
uncharacteristically haphazard way. I am not suggesting that Professor
Lecomte carried out her post-mortem haphazardly. I think she did a good
job, and, although I was later to uncover some errors, I have no criticism of
her. And I can very well understand her defensiveness when a British
pathologist arrived to ask insistent questions about how well she followed
her own procedures after she was woken suddenly for a particularly
demanding night’s work seven years earlier.
The Stevens inquiry cost £4 million and resulted in a 900-page report,
which was finally submitted at the end of 2006. It said, ‘Our conclusion is
that, on all the evidence available at this time, there was no conspiracy to
murder any of the occupants of the car. This was a tragic accident.’
The report did nothing to stop the conspiracy theorists, certainly not
Mohammed al-Fayed. In 2007, after much pressure, a full inquest was
announced. I was called as an expert witness and this time the French were
finally persuaded to produce more of their files. I had already seen Henri
Paul’s full post-mortem report, of course. Then, in late September, very
close to the start of the inquest, the French authorities finally released the
post-mortem photos of Henri Paul.
In 1997 police photographers used film cameras. The numbers on the
negatives were reproduced on the back of the prints and this meant it was
possible easily to follow the sequence of the pictures that were taken in the
mortuary. The first of the photographs clearly showed that Paul had been
placed face down at the start of the examination. In pathology you are
taught to look at the whole of the microscope slide – there’s always the
chance of a tiny bit of cancer at one edge. The same rule applies to
photographs. Ignore the blindingly obvious to begin with and look at the
background. So I looked at the background of the Paul photographs and
they showed a row of empty glass bottles, lined up and waiting for his
blood samples, on the sink beside the mortuary table behind the body.
Professor Lecomte’s report described a huge area of bleeding in the back
of Paul’s neck – probably caused by the impact from Dodi’s body. Nothing
unusual about that. But it was very odd that I could see more of the blood
bottles filling with each sequential picture. There were a number that were
evidently full before the body was turned over ready for the chest and
abdomen to be opened.
That would have no great significance except that, in her report,
Professor Lecomte states that the blood samples she submitted were taken
from the heart. And not from the neck.
Of course, she might first have taken samples from the neck as a
precaution and then discarded them when she turned the body over and
found she was able to take cardiac samples instead (cardiac samples are
regarded as acceptable: in fact, femoral samples are the best). That would
be good practice. But only if she recorded her actions.
Or she may have labelled blood samples from the neck as being from the
heart. It doesn’t matter so much where the samples are taken from. Saying
where they are taken from does matter. The site of sampling can
significantly affect the toxicologists’ interpretation of the results, and
incorrect labelling can lead to great inaccuracies.
You might take this as an oversight. You might take it as an indication of
poor record-keeping. But, in a case like this where every tiny event matters,
it can give rise to many more questions about sampling sites, labelling of
bottles and security of transfer – and it certainly fuelled the accusations that
these weren’t Paul’s blood samples anyway. Residual blood in the samples
was tested and proved to be Henri Paul’s but that did not end the matter
because there were missing samples, spilt samples, samples that had been
shared with other labs … leaving enough room for doubt for those who
really wanted to raise questions.
It was for the jury to decide the significance, if any, of the evidence I
gave to the inquest. This was a large-scale affair, presided over by Lord
Justice Scott Baker, who had been appointed coroner specifically to this
inquest. He was represented by three barristers, Mohammed al-Fayed by
three, there were two for the Ritz hotel in Paris and two for the family of
Henri Paul. In addition, the Metropolitan Police was represented by three
barristers and the Intelligence Service and Foreign Office by two. Other
interested parties, including Diana’s sons and her sister, also had lawyers at
the inquest.
Although, of course, there was considerable media attention at certain
points, most days the lawyers heavily outnumbered the totality of both press
and public.
Questioning of the witnesses, as usual at an inquest, came first from the
coroner’s barrister – but there was often cross-examination from one or
more of the others. Every tiny detail of that night and the months leading up
to it was examined. My own contribution was minimal but, I think,
important to the outcome. I was asked what my overall impression of the
events was. My conclusion? A simple, high-speed, alcohol-related, road
traffic accident.
The jury’s final verdict astonished no one and satisfied many:
Unlawful killing, grossly negligent driving of the following vehicles and of the Mercedes.
The crash was caused or contributed to by the speed and manner of driving of the
Mercedes, the speed and manner of driving of the following vehicles, the impairment of
the judgement of the driver of the Mercedes through alcohol.
I wish that Professor Lecomte had not been so resistant to Shepherd’s
charm offensive and had talked a little more: her silence does mean that,
pathologically speaking, there is a slight lack of clarity. But that doesn’t
mean I can credit conspiracy theories. I do not believe that what happened
in the mortuary that mad night was part of a wider plan to murder a woman
in such a haphazard way and then hide the evidence. Simply, Professor
Lecomte made small errors under pressure, which, in a case without so
many seeking fodder for their theories, would not have been significant. I
entirely concur with the jury’s verdict.
33
In 2006 Tony Blair was still prime minister, there was a summer heatwave
and CSI was named the world’s most popular TV programme. Chris was
almost a vet and Anna halfway through medical school. On the Isle of Man,
Simpson’s Forensic Medicine, Twelfth Edition had been not just finished but
published. My pride in it was tempered by the sense of finality the book’s
completion gave me. Reading the third edition had started my career. Was
the writing of the twelfth edition a sign my career was ending?
I still had plenty of work: sitting on committees, giving opinions on
complex cases and evidence at public inquiries. But life was very different
from that busy world I’d known before, a world that always had at its centre
a body, demise unexplained, name perhaps unknown.
Occasionally I began to experience a sense of ennui as I walked the hills
with the dogs and stared at the sea. What was it? It took a while for me to
recognize something I have barely experienced in the whole of my life.
Boredom. Or was it loneliness? I hardly knew what that was, either.
Alone together after some buzzing social event, Jen and I didn’t seem to
have much to say to each other. There was no need to discuss the children
like we used to now they were grown, and the cottage renovations were
finished so there was nothing much to say about that either. Jen bought
some sheep and started to learn how to manage her flock. I tried to develop
an interest in sheep, too. But the fact was, much as I loved our home
overlooking the sea, it had begun to seem very silent. I even welcomed the
noisy storms that banged on the windows and battered the roof, because
they made the house feel so alive.
When we moved to the island we had both thought there would be some
part-time work there, perhaps for me in the mortuary and surely for Jen in a
dermatology clinic. But this proved closed to us due to island medical
politics and Jen ended up spending one week a month working at a clinic on
the mainland. In 2006 I was offered forensic work as a weekend locum in
Liverpool. And I took it.
Maybe I had limped away from London to the Isle of Man feeling
battered by my working life. By its politics, its administrative
responsibilities, the interpersonal complexities of the new world of private
pathology. Only now did I realize what I missed: the very heart of my work,
that is, the dead and their mysteries. Standing in the Liverpool mortuary in
my scrubs, with my PM40 sharp in my hand, I even felt renewed
professional excitement for my first patient, one smelly and drunken knife
victim who had been found in a rubbish chute. This was standby forensic
work for the police and I stayed in a hotel for one weekend a month in order
to do it. Sometimes I was called out to a stream of homicides and
sometimes, to my great disappointment, nothing happened at all.
I hadn’t been away from hands-on work for long, just about two years,
but we seemed to be in a new era of forensic pathology. The changes
weren’t dramatic so much as a continuation of developments I had first
begun to notice in London.
Bodies were and are changing. Body fat has increased exponentially in
the population, so that unless a patient is homeless or has died of cancer or
is so old or poor they could not eat, few are the same shape as the dead of
the 1980s when I started practising. Looking back at forensic photos from
that era I am astonished at how thinness was then the norm.
Bodies also look different because they are so much more ornate: once
tattoos were for fighting men and sailors. Now it seems that the majority of
mortuary admissions have piercings or tattoos. In addition, self-harm was
almost unknown then and now I am amazed at the number of bodies,
particularly the young, which arrive in the mortuary with old, self-inflicted
cuts and lacerations: it tells me about their life and about changing society
but nothing about their death, the causes of which are generally not directly
related to self-harm.
For the pathologist in the 1980s, HIV and hepatitis were becoming the
acknowledged enemy, and they still are. But by the time I returned to work
from the Isle of Man, TB was an occupational hazard for anyone working in
a mortuary and I knew several pathologists and mortuary staff who had
caught it. TB is much more prevalent than you would guess and, not
uncommonly, even at post-mortem, we have no idea that we are about to be
exposed to a highly infectious disease which every other doctor has
mistaken for a simple pneumonia.
Post-mortem reports have changed too. When I started, three pages was
considered adequate. When I returned, I was criticized for producing
anything less than ten, and they were expected to be discursive, explaining
the workings of the human body at length.
Back in the 1990s, DNA started to make a significant contribution to
forensic work, and forensic science soon overtook forensic pathology as the
field’s major contribution to crime-cracking. Before I left, the police had
begun to ask us to wear gloves at the scene of a crime. By the time I came
back, it was gloves, boots, white Tylex suit (hood up), and a face mask too.
DNA analysis had become so much more sensitive that now we knew just
breathing, just talking, sprays saliva with DNA everywhere. Gone are the
days of the pathologist and senior investigating officer walking around the
scene in their office clothes discussing the case. The white suits are
certainly not designed for ease of dressing, nor for comfort, and it’s always
embarrassing to try to put one on when the world’s press is filming you. But
it is so good to take them off at the end of the scene examination and put
them in an evidence bag – yes, even the suits are kept for trace evidence
now.
In court I had for years noticed how cases for the prosecution were
becoming less meticulously researched and organized. Now, case
conferences with counsel are a thing of the past. There is never a phone
call: not from the police, the Crown Prosecution Service or even counsel. If
I am lucky, I’ll get ten minutes with the QC before I go into the witness
box. More often, barristers don’t have a clue what answers I’m going to
give when they stand up and start to question me. Often, they don’t even
allow me the chance to tell the jury who I am and why the years have
particularly qualified me to discuss this subject: ‘Dr Shepherd, you’re a
registered medical practitioner, tell me what you found on your examination
of the body.’
The days of the thundering, bombastic QC were already ending when I
left London: that defence QC who gave me such a hard time over the rent
boy’s all-over bruising was already a relic from the past and now such
barristers are almost completely gone. Presumably for economic reasons,
the Crown Prosecution Service seems to use junior barristers rather than
much more expensive QCs. Of course, experienced, although not so overtly
thundering, QCs are still out there, and they are nearly always working for
the defence.
Courts are much more interested in expert witnesses giving what is now
called ‘evidence-based’ testimony rather than experience-based, no matter
how much experience we have. Judges have occasionally stopped me
answering important questions fully with a curt, ‘Just give us a yes or no,
Dr Shepherd.’ Often when I am responding to a long and detailed question
from counsel.
The essentially self-employed structure of forensic pathology in England
and Wales that was introduced as I left London has removed almost
completely the possibility of forensic research. Most of us do not now work
or teach at universities: forensic medicine no longer even has a place on the
medical-school curriculum. Research has anyway been effectively neutered
by the Human Tissue Authority’s insistence that families of the deceased
give consent before samples, even minute samples, can be used for research
purposes. How then, you may ask, can the answers we give to the courts be
‘evidence-based’?
There will always be homicides and suicides and accidents, but now the
routine forensic caseload will, increasingly, include negligence and
‘safeguarding’ issues in nursing homes. It will certainly include a large
number of deaths from drug overdose. And, shamefully, there are many
more deaths in custody, which speaks volumes about our jails: 316 in the
year to March 2017, of which ninety-seven were suicides. In the same year,
there were in jails over 40,000 incidents of self-harm and over 26,000
assaults. And these figures are rising alarmingly year on year.
The most shocking change I noticed on my return is that forensic
pathologists are called to investigate a death less often. The cost and
administration of opening an inquest seems to encourage some coroners to
overlook an element of doubt. If there ‘might be’ a natural cause and a
doctor ‘might be’ willing to sign a form, many coroners will accept that
without too much inquiry. Sadly, the need for the police to pay a standard
fee, admittedly several thousand pounds, to a forensic pathologist, may be
enough to persuade them that a death (especially, it sometimes seems, one
close to the end of the financial year) really is not so suspicious after all and
can be dealt with by a local, non-forensic pathologist instead of one of the
forty or so specialists registered by the Home Office.
Most people would agree that a civilized society should endeavour
always to find, no matter what it costs, the true cause of death. The cost of
the trials, the inquest and public inquiry into the death of Stephen Lawrence
should serve to remind anyone in any doubt that it is far, far better and far,
far cheaper to do all things properly at the start.
I found that I enjoyed being back at the coalface in Liverpool, different
though it looked. I was sometimes invited to lecture on the mainland by
medical bodies or other professional groups, and I enjoyed that too. At the
end of these lectures, interested people usually came forward to ask me
questions. After one lecture in London, a forensic paediatrician chatted to
me about my work. A forensic paediatrician can expect to see cases of child
abuse, both physical and sexual, and this was, in fact, the paediatrician’s
specialization: not death, but the protection of the living. She asked me
questions about bruising and we agreed that, with our combined knowledge,
we really should write an academic paper on the subject. Our work
overlapped in that problem area between my research into whether a child
had died naturally and her research into whether living siblings were in
danger, and we met several times to discuss the paper on bruising during
my subsequent trips to the mainland.
On the Isle of Man, our house became more and more silent. Jen
shepherded her flock. I studied my papers.
One day, she said, ‘We really ought to discuss our marriage.’
And I said, ‘What marriage? It hardly seems to exist.’
That was how it ended. One night in February. Not with a bang but a
whimper. With little talk. But much pain. After thirty years.
How quickly, in comparison to its length, the marriage unravelled.
Perhaps every entity has a limited lifetime. Perhaps senescence is built into
relationships just as it is built into the human body. It seemed to me there
was simply nothing left of this marriage of ours but it was impossible to say
this, to think it, without inflicting pain and engendering fury. There was the
past and there were two children and a shared property and that, of course,
all had to be discussed, often acrimoniously, always with much pain on both
sides. But we shared so little else that I was sure, when the shouting was
over and the hurt receding, that better lives lay ahead for both of us.
Jen issued papers to divorce me and the process was complete within one
year.
It was not obvious to me at this time that I would fall in love with the
forensic paediatrician I had been meeting to discuss our work on bruising,
let alone that she would become my future wife, but I was never able to
persuade Jen of my innocence in this. It was true I was spending time with
someone whom I knew to be of special warmth, empathy and intelligence,
but there had been no further planning on my part. Nor on Linda’s. She had
been widowed when her three daughters were very small and for some
years now she had been in a relationship. That relationship and my marriage
both ended with mess and fury.
Despite her determination to divorce me, Jen suffered greatly. Our
separation caused considerable unhappiness to our children, too, who also, I
think, wrongly suspected that I had simply found Linda and dumped Jen.
Anna, almost a doctor herself now, during the period when her mother’s
pain was greatest and her anger red hot, declared that one thing she would
never become is a pathologist like her father.
I am glad to say that Jen did find happiness with a new partner. And in
September 2008 Linda and I were married. This added another family to
mine and I found myself back in the world of teenagers as well as busy,
elderly parents. No matter how loving and welcoming a new family,
relationships between each individual, between the two families, must be
built slowly, over years. We have applied ourselves to this and the result, I
hope, is a strong and loving extended unit.
Since that time, I have lived and worked as a forensic pathologist in the
north of England. Life here is rich and varied: stimulating work, a warm
and loving home, interesting holidays, surprise expeditions, a shared
aeroplane to fly, five children between us and, for me, two grandchildren
now.
My son, Chris, is a vet, specializing in horses. He now lives abroad,
where the landscapes and perhaps the mindscapes are wider. Anyway, he
has certainly escaped poor pay and dark mornings. And he is following me
in one way: by learning to fly.
Anna is a consultant histopathologist and, yes, she does have a keen
interest in post-mortem and forensic medicine and even works for some of
the coroners I worked for years ago. We chat often about cases: I seek her
advice on ‘newfangled’ tests and she seeks my opinion on causes of death.
She changed her name when she married and no one can say that her
father’s name is connected in any way with her achievements. But probably
no one would, because she is obviously very much her own person. Anna
doesn’t find herself torn between modern practice and a desire to be Keith
Simpson. No, Anna’s world is much more complex and accountable than
the one I knew at her age. I see that world as less colourful. But she doesn’t.
She never knew Simpson’s limitless horizons.
I would say that my knowledge of death has helped me appreciate the
importance of life’s small pleasures and I bask in them: a loved child
running excitedly through a carpet of red and yellow fallen leaves, or
tracing a finger with deep fascination along the wrinkles on my face, a fire
ablaze while rain throws itself against the window, a dog hurtling towards
me to welcome me home, a gentle hand placed lovingly on mine. I am no
stranger to joy. I know that joy can be truly experienced only by those who
have known adversity. And adversity is an inevitability.
34
One morning the phone rang and an angry voice cried, ‘Have you read this
crap? Have you?’
The voice was instantly recognizable as Ellie’s. She is a paediatric
pathologist with whom I’d worked on the occasional case. And the crap she
was referring to? We’d together performed a post-mortem on a baby named
Noah eighteen months ago and given SIDS as the cause of death. I’d
noticed there was something new about this case in my inbox, waiting to be
opened.
Ellie was unstoppable.
‘How can we have missed lip injuries and fractures on the posterior ribs
too? How? The lips were resuscitation injuries or I’m Naomi Campbell!
And we looked and didn’t see any posterior rib fractures and neither did the
radiologist. How is it that this person can just look at the photographs and
find suffocation injuries and old fractures? Tell me that, Dick!’
The parents of the late Baby Noah now had another baby. Social services
evidently felt there was enough doubt hanging over the earlier SIDS death
to safeguard the new baby by removing her from the parents’ care. Their
application to do so was heading for the Family Court. Recently the court
had asked for copies of our report on Baby Noah, our notes and the postmortem photographs. And evidently, all this had now been reviewed by
another pathologist who specialized in working for that court. I clicked on
the email. Yes, here were his comments.
‘Ellie, he’s surely not saying that we missed …’
‘He is!’
‘I’ll look at the pictures and call you back.’
I felt sick. Was it possible that I had examined a dead baby who had been
abused and murdered and failed to spot the evidence for this? And actually
given SIDS, exonerating the parents and endangering any future babies they
might have? And had the evidence been so obvious that eighteen months
later another pathologist could pick it up just from the photographs?
I dug out the file. Baby Noah was many cases ago. I tried to remember
that day.
I had been called to the mortuary by the police because the mother had
found her baby dead in the morning. Waiting for me in the lounge area next
to the inevitable mortuary fish tank was Ellie – the post-mortem of a child
whose death is suspicious must be carried out by two pathologists, one
forensic, one paediatric. Ellie is good to work with: witty and wise, she
demonstrates a 100 per cent certainty about her own conclusions that I
secretly envy.
Now I flicked through my notes. The mother gave Baby Noah a bottle at
8 p.m. and, since he was sniffling, also some paracetamol. He went to sleep
but had woken twice in the night. The first time, at about 2 a.m., the father
had rocked him back to sleep. The second time was at 5 a.m. and the father
was waking up anyway, since he was on an early shift. He settled the baby
and left the house at 6 a.m. without really waking the mother. At 7 a.m. she
had found the baby dead. She ran, screaming, into the street. A neighbour,
who had seen resuscitation techniques demonstrated on EastEnders, ran in
and attempted to revive the baby until the ambulance crew arrived to take
over. Without success.
Pictures of the home had shown the disorder one expects to find where
there is a new baby. There was little furniture because the place was
dominated by large, plastic toys of the kind Grandma buys at Argos. The
fridge was nearly empty except for milk and leftover takeaway cartons.
Upstairs the bedroom was almost filled by the bed and cot: there were piles
of baby clothes on the remaining floor area.
Most notable for us as pathologists was the temperature of the place. We
saw pictures of the boiler thermostat downstairs set to thirty degrees and
pictures of the bedroom radiators on max. The police had commented on
how hot the house was. There is, of course, a strong association between
SIDS and overheated babies.
Some time after we had completed our post-mortem report, a number of
anomalies and untruths emerged. Moslem neighbours were shocked to find
their bins full of empty alcohol bottles and mentioned this to the police.
Noah’s parents later admitted that they had disposed of these bottles in the
night. Toxicology extrapolated the father’s blood alcohol level at the time
the baby was supposed to have first woken at 200mg/ 100ml, two and a half
times the drink-drive limit. And the same tests revealed that both parents
had been smoking cannabis.
The father had an old GBH conviction after a fight, but there was no
history of domestic violence. The baby had an old shoulder injury, but this
could easily have been caused by his very difficult birth. The police were
clearly suspicious of this couple but could not really articulate why –
although they did find out that the house was so hot because there was a
small cannabis farm in the loft. The ambulance crew strongly suggested that
the baby had been dead for a few hours, not just one as the mother insisted.
But they weren’t sure. And all the marks on Baby Noah’s body could be
explained by the untrained resuscitation techniques of the neighbour and the
subsequent prolonged attempts of the ambulance crew.
Ellie and I had to agree on a cause of death. As the paediatric pathologist,
she was going to write the report and I would make any corrections and
then sign it.
Ellie was sure she knew what she wanted to say.
‘SIDS, Dick. It’s SIDS.’
‘But there’s too much about it that’s not quite right. I’d rather give
“Unascertained”.’
‘We’re not here to pass judgement on them for having a few cannabis
plants in the attic, for heaven’s sake. Or for liking a drink. They’re
obviously not a chaotic pair of addicts. The father has a regular job, the
baby was healthy and well cared for, they turned up for all their healthvisitor appointments and vaccinations, there was a supportive wider family
– the grandma, the sister. No, don’t let’s leave “Unascertained” hanging
over a young couple who’re simply poor and doing their best.’
SIDS it was, then.
Except now another pathologist had looked at the post-mortem pictures
and decided it wasn’t.
I put the pictures up on the screen. Here were the baby’s lips. They were
redder than I remembered and the marks on them were more prominent, but
there was no swelling or bruising. These were injuries caused during
resuscitation. I then looked for the serial pictures of the inside of the chest
showing the baby’s ribs. Sure enough, I could see some whitening in some
areas. Which might indicate old fractures. Or was it just the glare from the
photographer’s flash?
I phoned Ellie back: ‘The lips look redder and more marked in these
pictures than they really were and there are actually some areas that look
white on the back of the ribs –’ I could hear her exploding so I went on
quickly. ‘We know that’s not how it was. If you look at the pictures closely
enough, you’ll see some of the other organs are odd colours and there seem
to be flash reflections littering the images. It’s the photos.’
‘Who took them?’ she roared. ‘Who took these rubbish pictures?’
I remembered how a SOCO had stepped forward rather shyly with the
camera. Had it been his first ‘proper’ job? He had asked his senior for
advice several times and then the auxiliary flash had stopped working, and
he eventually had to rely on the camera’s own built-in flash.
When I looked through the rest of the photos I saw their quality was so
poor that Baby Noah’s white nappy had a distinct blue hue. Why hadn’t I
noticed this earlier?
‘Don’t worry, Ellie,’ I said. ‘It must just be a technical problem with the
flash and it’s been made worse by the low resolution they’ve used to store
the images.’
‘I’m not worried,’ she told me coolly. ‘Nope. I’m very, very angry. This
pathologist who’s criticized us doesn’t do post-mortems himself. And he
certainly wasn’t present at this one. The other forensic pathologists who
looked at the body on behalf of the family agreed with us, didn’t they? How
dare he challenge us when –?’
‘Because … well, have you read the rest of the file yet?’
‘No I have not!’
‘Because they’ve now found out all sorts of things about the parents.
Stuff they didn’t know before. Which gives a different picture. We thought
they were young and struggling and trying to make ends meet with their
little cannabis farm in the loft … but now it turns out that the father already
had a baby with someone else, down south somewhere. About four years
ago. And it died. SIDS was given as the cause of death.’
That silenced even Ellie for a moment.
I said, ‘It doesn’t help that he’s a former heroin addict who until quite
recently had a methadone script. I wish they’d told us all that.’
‘Oh, go on. Just victimize a man when he’s doing his best to get clean.
Was he on methadone when the baby died?’
‘No.’
‘There you are, then.’
‘When he met the mother and had the baby he was really trying to live a
better life; that’s how I read his police interviews.’
‘Exactly, and if we took every baby away from every recovering heroin
addict, there wouldn’t be any children left in some parts of town.’
‘Listen, Ellie, we’ll go to court, give our evidence, explain that the
photos are faulty and we’re sure the child did not have old fractures, explain
that the radiologist agrees with us, and that will be an end to it.’
‘It won’t be so simple. We’ve given SIDS and they don’t want to hear
that. I think they just want to take the next child away. It’s quite clear they
believe Baby Noah was killed.’
‘Courts are briefed to find the truth, not what they want to hear.’
There was a loud noise halfway between a laugh and a snort and then she
was gone.
The court case really didn’t worry me. In fact, I was quite curious. The
Family Courts have retained their mystery for me as for everyone else
because until now only my written evidence had been used. These courts
deal with such personal, sensitive issues that they are absolutely closed to
press and public: no one without a direct reason to be there is admitted, not
even close relatives of the deceased or their family.
Ellie was waiting for me outside. She looked nervous.
‘You should see how many people are in there.’
‘How? Virtually no one’s allowed in apart from lawyers and witnesses.’
‘There are a trillion lawyers. The mother has a solicitor, a junior barrister
and a QC. So does the father. So does the local authority. So does the new
baby! Not three months old and she already has three lawyers! So that’s
twelve of them for starters, then there are loads of officials. Dick, now
they’re cutting back legal aid for criminal cases, lawyers must be into the
Family Courts like vultures. Cases last for weeks here!’
I thought she was probably exaggerating.
‘Just as well there’s only one judge, then,’ I said. ‘Sounds as though there
wouldn’t be room for a jury too.’
But once inside the courtroom I saw that the place was indeed thronged
with lawyers. No one was technically on trial, of course. The defendant’s
box was empty. It was one judge’s job to decide whether a baby should be
taken into care or perhaps safeguarded in some other way. There were lots
of factors he would take into account but whether, on the balance of
probabilities, a parent had injured or killed Baby Noah was the central
question. No trial then, just an investigation into the truth. But with a full
adversarial presentation, barristers each questioning, cross-examining and
arguing their clients’ case. I recalled that, as Aeschylus allegedly said, the
first casualty of war is truth.
I was allowed to sit in the courtroom during Ellie’s testimony and so was
able to see both parents. They sat separately and did not look at each other.
They had a new baby but they seemed not to be together: of course, their
legal teams would each now be playing the blame game.
The mother was angry. Overweight, barely moving, her face large as
though swollen, she managed to create a sense of noise around her,
swearing into the ear of her solicitor and sometimes out loud into the quiet
courtroom. The father was very thin and he sniffed and fidgeted constantly
as though the proceedings were keeping him from something more
important. Like a fix. If they had really killed Baby Noah they were not to
be pitied. But if they hadn’t … they looked like two unhappy, unloved
people who perhaps had struggled to learn to love their baby.
In the witness box, Ellie was losing her cool. I watched with growing
concern as barrister after barrister attempted to question her competence in
giving SIDS as Baby Noah’s cause of death. When they had finished
mauling her, I knew what was coming next.
Almost as soon as I had taken the oath, the first barrister began by
pointing out that the baby had in fact been wearing a blue Babygro with
green rabbits on it – annoyingly, Ellie had reversed the colours in the postmortem report and I had failed to notice that the rabbits weren’t blue when I
checked it. She had also made one small mistake over a date, reversing the
month and day, which I had, once again, failed to notice. Not major errors
but it was the usual quibbling at the start of an examination designed to
challenge my competence and undermine my confidence before the big
fight. And the big fight was, of course, going to be the baby’s lip injuries
and the alleged fractures to the posterior ribs.
‘Dr Shepherd, do you agree that old, now healed, fractures to the baby’s
back ribs would be a strong indicator of abuse over his short lifetime?’
‘I agree that, if there had been healed fractures, abuse would be one
possible explanation.’
‘Did you look for such fractures?’
‘All the ribs were examined extremely carefully …’
I pointed out that the photos were poor and did not represent what we
actually saw. This was brushed aside: ‘We can all see that the back ribs
were previously fractured in the photos, Dr Shepherd. So why can’t you?’
We had the same conversation about the lip injuries.
‘Just look at the photographs, Dr Shepherd! The presence of injuries is
obvious!’
I explained that, because of the way the images were stored, transmitted
and then printed on a poor quality printer, they could not be relied upon. It
was clear, though, that I wasn’t making any progress. They could see what
they could see. I was either blind or stupid not to accept that and – if I was
either – I was obviously deliberately obfuscating to avoid the fact that I –
we, Ellie and I – with seventy years of pathological experience between us,
had dismissed suffocation injuries as resuscitation injuries.
There followed as demanding an afternoon as I have ever spent in the
witness box of any court, including the Old Bailey. And, in a way, it was
worse – instead of one hostile barrister, there were many, representing all
sides, each attacking me from a different angle. I managed to hold my
ground, acknowledging the possibility that we could have been wrong but
saying it was highly unlikely that two experienced pathologists would have
missed such clear evidence of abuse.
‘Are you an osteopathologist, Dr Shepherd?’
‘No, I am not.’
‘But you were concerned about the baby’s ribs, the evident fractures at
the front?’
‘Concerned that the fractures were open to interpretation, yes, but aware
that violent resuscitation by an untrained neighbour had –’
‘You were concerned, but not concerned enough to submit the ribs to an
osteopathologist for his specialist comments?’
‘It did not seem to me that he could shed any further light on the ribs. We
had seen which ones were broken and we knew that –’
‘You thought you knew as much as the specialist, is that it?’
‘The radiologist said, in her opinion, there were no fractures at the back
of the ribs. We had easily seen the fractures at the front. I felt the further
knowledge of an osteopathologist would add nothing.’
‘Wasn’t that rather arrogant of you, Dr Shepherd?’
‘I do not consider myself an arrogant person. I am sorry if I appear that
way.’
Alexander Pope’s lines appeared in my head as if my father had just
inserted them there.
But you, with Pleasure own your Errors past,
And make each Day a Critick on the last.
‘Do you admit the possibility that you were wrong to give SIDS?’
‘Assessment of a cause of death in these cases is always very difficult,
there’s a very fine line. On the evidence we had when we wrote our reports,
SIDS took precedence. Had we been given fuller information about the
circumstances of the baby’s life and death, I believe we would probably
have chosen “Unascertained” instead.’
The surprise of my afternoon at the Family Court was not just the attacks
on me professionally, but personally. The second surprise was the written
judgment. It arrived some weeks later. I learned from it that there had been
a series of witnesses in court over the weeks of the case who gave examples
of how neglected Baby Noah had been by his parents. The mother had now
emerged as an alcoholic, the father as a frequent drug abuser. The mother’s
sister and an aunt had been stepping in to help with Baby Noah,
inadvertently promoting a false impression of the mother’s competence to
the health visitor and others. According to the judge, it was they who had
ensured the baby was looked after and taken to his appointments and
vaccinations.
He said that Baby Noah had been neglected and he was shocked by the
refusal or inability of the two pathologists who examined the body to accept
that they had missed such obvious and glaring marks of abuse – which
could be seen in the photos by anyone. Indeed, he said the pathologists still
seemed to think that SIDS might well be the cause of death. The judge did
not make any mention that the photos were of, at best, variable quality. Nor
of the lack of information provided to us about the parents on the day their
baby died when we had carried out the post-mortem. Nor of any failure to
update us as further information about the family was uncovered.
He went on to say that, on the balance of probabilities – which was the
test he had to apply – he concluded that the father had killed Baby Noah.
Under cross-examination it had been revealed that, on the night of the
baby’s death, large quantities of drink and some drugs had been consumed
and when the baby cried, the father had responded. The judge supposed that
he probably did this by pressing down on the baby’s chest, and possibly his
face, asphyxiating him and perhaps breaking his ribs. There was evidence,
he said, from the baby’s posterior ribs, that something like this had in fact
happened before. On this occasion, the mother had asked him to do
anything to stop the baby crying and, although she was aware that he was
behaving harshly to Baby Noah, she did nothing to intervene. Therefore, no
other child should be left in the care of either parent. Their new baby was to
be taken from them for adoption.
I cannot imagine how the parents of Baby Noah felt on receiving that
judgment. I was so crushed by it that I believe I actually gasped for breath.
It was impossible that harsh words from a judge about a Home Office
pathologist would not cause considerable repercussions. I had reached the
age of sixty and had tried hard to work through medicine in the interests of
justice all my life. And now it seemed that balance and justice were being
withheld from me.
That night, I could not sleep. I could barely breathe. Such critical
comments must require investigation and, as a Home Office pathologist, I
must report them to the Home Office. Would the Home Office then
investigate me? Refer me to the General Medical Council? The GMC can
take away from doctors the right to practise if they are found guilty of
serious misconduct.
The unfairness of this possibility made me sit up in bed. I was being
accused of poor judgement on the basis of poor photos. Injuries on the lips
and healed cracks in the posterior ribs could be evidence of old abuse but
there had been no injuries to the lips and the fronts of the ribs that couldn’t
be explained by resuscitation, and no cracks at the backs of the ribs at all. I
was sure of it, Ellie was sure of it, the radiologist was sure of it. We had
said in our report that, although the injuries to the front ribs were probably
caused by resuscitation, we could not exclude the possibility that they had
been caused deliberately. But then, of course, we had given SIDS as the
cause of death.
Surely, surely, it was impossible that I would be struck off for such a
thing?
When at last I slept, my dreams were a strange jumble of courtrooms and
babies. The next day my night thoughts still shrouded me. Without thinking
about the court case directly it nevertheless informed my every action. In
my stomach, the patina of dread. In my head, a sense of crisis. Sitting at my
desk that afternoon, tortured by inexplicable anxiety, I stopped fighting. I
knew what was going to happen. It had started to happen flying over
Hungerford recently. Then again after the Paris bombings. I had learned to
clench my fist and with a supreme force of will almost keep myself away
from the abyss. But now it opened right in front of me.
I shut my eyes. It was waiting for me. The bodies, piled high, the stench
of decay and heat, young people who had been dancing when the bomb
went off, when the boat went down, young people without hands, children
exhumed in their coffins, babies’ tiny bodies bearing helpless testament to
man’s inhumanity, charred bodies, drowned bodies, bodies severed on the
railway track. A deep, deep pit of human suffering.
I looked up again. I blinked. I looked around my office. Computer, desk,
pictures, files, dogs. All normal. It had been another of those quick trips to
hell again, as sudden and shocking as an epileptic fit.
And anyway, I was back in the present now. I was going to get on with
my work. Which was to write to the Home Office reporting the judge’s
comments about me in the Baby Noah case.
A short while later, the Home Office replied. They were already aware of
the case and said they had been for some time. Although they hadn’t
bothered to let me know. The police officer involved in the case had
reported me to them and they had decided to pass the file to the General
Medical Council. I might, they said, wish to discuss the matter with my
lawyer.
I most certainly did. She was reassuring but I was not reassured. At night
my dreams were hideous. In the day, awake in my office, I fought with
nightmares.
At last, a letter arrived. I opened it with shaking hands. I wanted it to tell
me that the whole thing had been dismissed and that it was over.
It said I was under investigation by the General Medical Council. My
competence had been called into question because of the cause of death
given in Baby Noah’s post-mortem report, signed by me.
Then, all joy stopped. And those events that I had not been calling panic
attacks? Well, even I had to admit that’s exactly what they were.
I have spent my entire working life reviewing cases. Now I was a case.
Now I was under review. The GMC is essentially a private court that
investigates at its own pace and behind closed doors. It gives no
information about the length of time it will take to resolve issues and does
not communicate on the matter other than to issue edicts – to which I had to
respond within a very short time frame.
I knew the GMC was quietly contacting colleagues, coroners, police
officers, anyone who had worked with me, for their opinions of me and of
my skills. The GMC did not say whether or when it might refer my case to
the next level, the tribunal. I would be informed when that referral was
made.
The tribunal is the Medical Practitioners Tribunal Service, which is
independent of the GMC and adjudicates cases sent to it by the GMC. It
hears evidence on oath, with examination and cross-examination by
barristers, and they return a verdict on whether a doctor is fit to practise. Or
not. It is, effectively, a court.
All this because another pathologist who worked for the Family Court
suggested I made mistakes, that I missed obvious injuries and gave a cause
of death for Baby Noah that he considered incorrect. Pathology is a
combination of facts, experience and judgement. But the tribunal could
ignore this and conclude from the accusations made that I was not
trustworthy to determine how a child had died and therefore whether
siblings were at risk. They could decide I should be ‘struck off’. That is,
removed from the register of doctors considered fit to practise.
Once the GMC investigation began, I started to experience, with renewed
and alarming frequency, more panic attacks. Sequences of heart-stopping,
heartbreaking images completely took over my mind.
I tried to adopt a detached, medical view of this. So, these ambushes had
started when I was flying over Hungerford one day. Why exactly had they
started, why exactly had they stopped? Obviously the GMC investigation
had triggered their ugly and forceful return. Had this public doubting of a
man who is supposed never to be wrong opened up a chasm of hidden
fears? And were these fears now out of control?
There were no answers. Only images that inhabited my head suddenly
and totally at the most unexpected moments. All I had to do was put some
ice in Linda’s drink and I was back in Bali, staring at the young bodies
rotting beneath their bags of melting ice. There was no question of my
opening any of the files piled in my office. Because inside them lurked
pictures. And there were already too many pictures inside my head to
manage. A sense of dread immobilized me. I was filled with a horror that I
can only call unquenchable. The stench of death never left me.
Each ambush robbed me of sleep, stripped me of pleasures, tormented me
with worry, filled me with self-doubt. The loss of my ability to rest was
soon followed by the loss of my ability to read. Because I couldn’t make the
decision to pick up a book, or to open it. I couldn’t make any decision at all.
Would I like a cup of tea? I had no idea. I barely knew whether to get up in
the morning, let alone bother to get dressed. The future? It didn’t exist.
Everything I thought I had known or cared about suddenly had no meaning.
Much of the day I simply concentrated on trying not to blink, since I had
noticed the images that hovered over me, waiting to kidnap my mind, were
quick to pounce when I closed my eyes.
One hot summer morning my mind was pursued by rotting body
fragments. There were intestines. Spongy livers. Hearts that did not beat.
Hands. Here was one wearing a wedding ring. I had to prise it off to read
the inscription so that I could find out whose hand it was. The clawing
stench of decay took my breath away.
I thought it was better to die than live like this.
But how?
Railway lines are quick but they are selfish. People who appear in front
of trains cause trauma for the driver and create an unforgettable mess which
will torment loved ones for ever. Hanging might not work, or not very
quickly. A gun would be good, but how could I get one? Driving my car off
a cliff seemed like a clean option. I’d have to find a suitable, accessible
cliff, though. Difficult when I barely felt able to change out of second
without crashing the gears.
I don’t know what I was doing or saying because I could only see the
world from inside my head, and it was not a world in which anyone would
want to go on living. My actions, whatever they were, greatly alarmed
Linda. I was taken, unprotestingly, to A&E, where I was referred to a
psychiatric team. Sane, sensible, senior pathologist Dr Richard Shepherd sat
and quivered as a psychiatrist gently asked him to share the images he was
seeing. I tried to describe them. But no words came out.
It wasn’t a difficult diagnosis. I dare say every person reading this book
has already diagnosed post-traumatic stress disorder. Apparently, I was
alone in not recognizing its symptoms.
My PTSD is not caused by any particular one of the 23,000 bodies on
which I have performed post-mortems. And it is not caused by all of them.
It is not caused by any particular disaster I have been involved in clearing
up. And it is not caused by all of them. It is caused, in its entirety, by a
lifetime of bearing first-hand witness to, on behalf of everyone – courts,
relatives, public, society – man’s inhumanity to man.
The result of this diagnosis?
The summer of 2016 off work.
Two cures: talking and pharmaceutical.
And this book.
I was scheduled to return to post-mortems in the autumn, but I did not see
how I could ever work again. I did not see how I could cut arteries into tiny
sections again, or lift brains out of skulls again or examine the insides of
faces again or stand in the middle of an overflowing mortuary after another
disaster with a queue of the dead waiting for me. Again and again and
again. My future as a forensic pathologist was unimaginable.
Then, there was a change, small at first. I started to talk. I remembered
how Jen and I had sat together in the counselling room in Clapham all those
years ago, how my mind had wandered but my mouth had stayed, for the
most part, closed. Now, in a quiet room with a sympathetic professional, I
allowed my mind to wander – just a little bit at first – and then told the
professional where I’d been. It was a dangerous game, letting my mind
stroll off where it would. Because God knows what it would get up to if I
didn’t keep it firmly under control. But with a professional in attendance I,
very slowly, week by week, controlled the release of my thoughts. And I
found that, by reporting on my excursions to hell, they became fewer. Bit
by bit.
One day, quite recently, I began to feel better. There was still no word
from the GMC and I really had no idea where the summer had gone or how
it had become autumn but suddenly, almost as suddenly as that first panic
attack over Hungerford, my acute anxiety lifted. The massive boulder that
was going to roll over me any minute lost momentum. The dread that had
weighed so much that my feet could not walk and my mind could not think,
rose up and floated lightly away like a radioactive cloud.
It was replaced by an intimation, perhaps the ghost, of my former
pleasure in life. I knew this couldn’t last, that it was just a glimpse of
normality, but it was enough for now. I wanted to grab the moment, get in a
plane and fly it, to feel the thrill of take-off, to rise above the small, the
mundane and the everyday. But of course, after my summer of madness, I
had been forced temporarily to surrender my pilot’s licence.
I burst in on Linda, who was working at her desk, frowning slightly over
a child-abuse case that was soon due in court.
‘Let’s go for a walk!’ I yelled. Too loudly, perhaps. She looked at me
strangely but stopped typing at once.
And so we put the old dog and the new puppy in the car and it seemed to
me that the autumn sun was burning more intensely than it had all summer.
The brilliance of the countryside astonished me, as if I had never been out
of town in my life before. When we arrived in a wild place, the leaves were
so gold and rustling they looked like lamps on the hillside. The puppy ran
round and round in excited circles, barking, and even the old dog
scampered a little. The world was lovely, it was dressed magnificently, as
though for a party. All summer it had been wearing its finest clothes and all
summer I had rudely failed to notice or admire it.
Linda said, ‘You look …’
‘Better?’
She nodded and I saw her face alter without moving, as if, according to
some secret rule and very subtly, each cell had just changed position. She
didn’t even have to smile to look happy now. How hard PTSD is for those
who have to watch it.
I tried to absorb the hillside and the leaves and the dogs and Linda and
the world’s beauty, to guzzle it the way some men guzzle beer, consume all
I could before the darkness closed in on me again. Because I knew it must.
Cured is not, unfortunately, a word in the PTSD lexicon. But that glimpse
of a world without sickness – it must have lasted two, maybe three hours –
was enough to make me long for more, to give me the energy to reach for
more. The next intimation of normality would last longer. Eventually, one
lasted a whole day. Gradually the world of colour and beauty began to
reform itself around me, like a jigsaw.
There were (and still are) many regressive moments, of course. If Linda
had a drink she made sure she put the ice in it herself. Any communication
from my solicitor about the GMC investigation, even just saying there was
no news, left me incapable of action for a day, as though she had physically
pushed me over. In the office, there were some files I knew I still had to
avoid, containing images I could not see. Even this book, which I had been
writing on and off for a year or two and finally put to one side, still had
chapters I preferred not to revisit for now. But the summer taught me that I
wanted to finish it, that I did not want my life’s work, forensic pathology, to
be a ghostly, ghastly secret from the public. Because talking about the
things a civilized society requires civilized people to do makes all of us
healthier.
Then, one day, the phone rang and it was my solicitor. She hadn’t
received the letter yet but she had been told it was on its way. The case
against me had been dropped. Suddenly. Without consultation or
explanation, as it had begun. It had not even got anywhere near the tribunal.
I can’t call this really a champagne moment. I had travelled too long and
too painfully for that. But a weight did lift. The world did look clearer,
sharper, as if someone had refocused my lens. For a few minutes, I didn’t
know what to feel. GMC investigation or no, a deep fissure had opened up
in my psyche which would always be there.
When I told Linda the good news, the relief and happiness on her face
reflected back at me and I began to feel something of her joy and then
perhaps a little of my own. So many years of service were not going to end
in a welter of unjust accusations. I could carry on. If I wanted to.
It was frightening to return to work. I agreed the date, but as it approached I
felt that I really could not do it. The psychologist reminded me that I had
been learning to manage bad memories. She was right. I could get them out
and review them when I wanted to and then put them back in the drawer
when I wanted to. They wouldn’t go away. But they could be managed. I
would return to work.
As I walked into the mortuary on my first day back there was a moment
when I smelled the place, when the door closed behind me, a moment in
which I lost momentum.
I stopped still.
I could not go forward. And I could not go back. It was unbearable to
enter, unthinkable to run away. I hovered, my mind clouding. And at that
moment, the police officers arrived.
‘Hello, Doc, good to see you again, how are you?’
I couldn’t turn back now. But I didn’t have to move on either, we were
going to greet each other and talk right here. I stayed put.
The detective was a man I knew and liked. He said, ‘Got a very strange
case for you today, looking forward to seeing what you make of it.’
A very strange case, eh? It must have been those words that propelled me
forward. Five minutes later I was sitting on a sofa with a mug of hot tea in
one hand and a biscuit in the other.
The detective looked through his notes.
‘Deceased is in her fifties, a complete drunk and a bit of a handful,
frankly. Her son-in-law borrowed some money and then left her daughter
and never gave back the money, so one day this lady has a few and decides
to go to his house and confront him. Lots of shouting and swearing. He says
he was steering her gently off the premises but she was so drunk she fell.
She said he pushed her. Either way, she ends up on the ground.’
This wasn’t sounding strange at all. It happens all the time in my world.
‘And did he push her?’ I asked.
‘We think he did. Although initially his new girlfriend said he didn’t –
and she’s the only witness.’
Nothing strange yet.
I could hear the clangs of the fridge doors as bodies were rolled in and
out of them. I swallowed. The sound evoked many disasters, many bodies. I
tried to concentrate on the detective.
‘The question for you, Doc, is: if he pushed her over, is that what killed
her?’
‘So how long after the fall did she die?’
‘Days and days. She’s on the ground and she can’t get up. He calls an
ambulance. The hospital tells her she’s got a fracture in her pelvis and
there’s not much anyone can do about that. Just keep taking the painkillers.
That’s the normal treatment. And the fact is, she was shouting and swearing
at the staff in A&E and they couldn’t get rid of her fast enough …’
Was this going to turn into a medical negligence case? I took a sip of tea.
It was beginning to get interesting.
‘She goes to stay with the daughter, where she’s given lots and lots of her
favourite tipple. But she’s in agony and no amount of booze and painkillers
help. Finally, a few days later, the daughter calls an ambulance. Different
hospital this time. They say she has not one but five fractures of the pelvis
and needs to stay in. But she’s gasping for breath and the orthopaedic team
decide that she should go to a medical ward because her asthma’s so bad.’
‘And the medical team agreed? More fool them. So she’s an asthmatic
alcoholic with a badly broken pelvis?’
‘I think she’s epileptic as well, actually …’ The detective passed me the
hospital notes and continued while I glanced at the file. Osteoporosis.
Asthma. Alcoholism. Epilepsy …
‘Oh, and diabetes too,’ I said.
‘This woman was a death waiting to happen,’ said one of the police
officers. ‘She sounds like a medical dictionary.’
The detective was quick: ‘But that doesn’t mean she died of natural
causes.’
‘It doesn’t,’ I agreed. ‘So, what happened next?’
‘Well, on the medical ward they notice that she has extreme coughing fits
and they treat her for asthma and a chest infection. She coughs and coughs,
apparently until she faints. After about five days she has another one of
these massive coughing fits. Only this time she collapses and dies.’
‘What did the hospital do?’
‘Resus, of course. They thought it was … er … pull … pull …’
I said, ‘A pulmonary embolism? Pelvic fractures and she’d been lying in
bed for days, it’s the obvious diagnosis.’
‘That’s the one. Anyway, they gave resus and some stuff to, er …’
‘To dissolve blood clots.’
I was sorry at that. It was certainly the right thing to do but it didn’t save
the patient and it certainly hadn’t helped the pathologist. Because, if there
had been a blood clot for me to find, now it would be dissolved.
‘We were waiting for her to get better to discuss the GBH charge against
the son-in-law and when we rang the hospital to ask if we could question
her, the nurse says, “Oh, we forgot to tell you, she’s dead.” So suddenly it’s
not GBH, it’s manslaughter.’
I finished my tea. Now this had become a strange case. I’d just been
presented with five possible causes of death, and it still might be something
else entirely. Only her body could tell us why she had died and it was
waiting for us now. I stood up. I was curious about this mystery.
‘Right. Let’s take a look at her.’
On the way into the post-mortem room, I said to the detective, ‘This is
your department, not mine, but you haven’t got a lot of evidence that the
son-in-law pushed her. If she was drunk she could have fallen over and
injured herself before she even arrived at his house.’
‘We’ve got the girlfriend, actually. She’s split up with him. And now
she’s changed her statement. Says she saw him push the woman over and
push her hard.’
Hmmm. No jury is impressed with witnesses changing their statements
by 180 degrees.
‘And,’ he added, ‘we have CCTV footage of the deceased about five
minutes before she went to the son-i n-law’s and she had no problems
walking then. So what we really need in order to prosecute is your
evidence, Doc.’
I would look for that evidence. But with a constant awareness that there
was a manslaughter charge and the possibility of a prison sentence hanging
over the defendant. I must be absolutely sure I was right before I could give
the police my statement.
The woman was fifty-six and looked ninety-six.
‘Are you sure we’ve got her age right?’ I asked.
The police officer nodded.
I examined the exterior of her bloated body. It was peppered with
abrasions and scars, as the bodies of alcoholics often are. Each would have
to be measured and described. I made my notes and kept the photographer
busy.
‘What quality of image do you set on the camera?’ I asked him.
He looked at me, surprised.
‘The lowest, Doc.’
I was fascinated. ‘Why the lowest – surely you want the best-quality
images possible?’
‘True,’ he said, ‘but the police computer system can’t cope with big files
and so we have to use low quality.’
There was no answer to this acceptance of inaccuracy, and I could hear
no apparent distress in his voice. It was from his point of view a simple and
sensible conclusion, given the poor computer system. It didn’t seem to
matter that the photos he took would be used to convict hundreds of people.
And had nearly finished off my career. I just sighed. What else could I do?
Then it was time to make my first incision. I stood at the patient’s right
side, PM40 in hand. It felt like many long years since the last time I had
stood by a naked, dead body. Did I really want to do this? Store up more
bad memories in that hideous scrapbook inside my head that could still
open, without warning, at any time?
I gradually exposed the body, entering the abdominal cavity using a
unique cut. Unique because I had invented it. Let’s call it the Shepherd cut.
Instead of slicing the muscles down the midline, I cut along the bottom of
the ribs and down the sides of the abdomen. Then I fold down the muscles
of the abdominal wall, like opening the lid of a box. Neat, effective. And I
found here, around the fractured pelvis, extensive blood in the muscles and
tissues.
‘Looking promising!’ said the detective happily.
‘She was certainly haemorrhaging,’ I agreed, baling out the blood and
then looking at the body’s internal organs lying in the chest and abdominal
cavities, ‘but none of it looks recent.’
As I stared and lifted and poked, the roadmap of her life lay before me.
‘Is that her liver?’ asked a police officer, pointing to a small, grey organ
lying across the top of her abdomen. Even a layman could tell this had not
been a healthy organ for a very long time. ‘Looks like a dead parrot.’
‘You won’t need to pickle it, Doc, she’s already pickled it for you,’ said
another.
The detective was shaking his head. He said, ‘Doc, please don’t tell me
her liver killed her.’
I said, ‘I agree it looks awful, but I’ll know exactly how bad when I can
get it under a microscope … her lungs don’t look too good either. Quite a
bit of emphysema here.’
The deceased had spent her life by a very busy main road or she had
worked in a dirty factory or she had smoked heavily. Her lungs were dark,
quite black in areas, and they were pitted by numerous big holes.
‘I don’t want to hear her asthma killed her either,’ said the detective
gloomily. ‘And if you say she had a heart problem too, I’ll cry.’
‘She probably did with this little lot. I’ll have to get her heart out to look
at it properly.’
‘Doc, don’t give me natural causes. I’d really like to nick him. This
woman may only be fifty-six but she looks really old and frail and he’s a
big bloke and he shoved her over hard and she broke her pelvis in five
places and then she died. He shouldn’t get away with it.’
I said, ‘Her family might have a case against the first hospital for sending
her away with just paracetamol when she had five pelvic fractures. Unless,
of course, she fell at her daughter’s afterwards and got the other four …’
‘The daughter’s not saying, but we’ll get the X-rays from the first
hospital checked,’ said the detective, making a note. ‘I’m not really
interested in cases against hospitals, though. She got the fracture in the first
place because he pushed her.’
‘How could she die of a broken pelvis anyway?’ asked another officer.
‘An indirect cause of death from a broken pelvis would be a pulmonary
embolism: she’d been lying in a hospital bed for days and that means a
blood clot could easily have developed in her legs and found its way
through the blood vessels into her lungs. Unfortunately, the hospital gave
her medication during resuscitation to break up any clots so I’m unlikely to
find that – if it was ever there.’
‘Oh God,’ said the detective. ‘We need evidence.’
‘Well, another common cause of death after a fracture is a different type
of embolism called a fat embolism. We don’t know how this happens.
Maybe fat from the bone marrow at the fracture site finds its way through
damaged blood vessels and into the lungs. Once it’s there it can be carried
through the lungs and then it can get to the heart, the kidneys, the brain …
it’s often fatal. Odd thing is that it takes about a week from the trauma to
death.’
‘Ah!’ The detective’s face was brightening. ‘When will you know if she’s
got that?’
‘She’s probably got it to some extent, a lot of people do after a fracture,
after all sorts of things. It’s a question of degree … I need to know just how
many fat emboli she has, and if that number is significant, before I can say
that’s the cause of death.’
‘When will you know, Doc?’
‘About a week, but of course we’re waiting for toxicology anyway.’
The detective looked at me. He said, ‘I told you it was a strange case.’
I grinned back at him. ‘Yes,’ I agreed, ‘it is.’
I thought about the case a lot. But not the next day. Because I had just got
my pilot’s licence back and now I went flying. Alone, I was suspended by
nothing in the middle of nothing with the amazing feast that is the English
countryside spread out below me and, in the distance, the deep, sombre blue
of the sea. The plane soared. I soared. My thoughts were as gloriously
uncluttered as the sky, as the sea.
A week or so later I met the same detective again at another post-mortem.
Another strange case.
A man had come out of the pub and later been found dead in a river. His
family were convinced that he’d been knocked out by an assailant and then
chucked in the water.
‘Well?’ said the detective from across the post-mortem table. ‘Had any
luck yet finding the cause of death for the drunken woman who got pushed
over?’
I was running an eye over the man from the river. I had a theory about
him.
‘I’ve been agonizing over it. That woman really was a complex case. I
did find quite a few fat emboli in her lungs and brain but, according to the
research, not quite enough to be one hundred per cent sure they were fatal.’
He groaned.
‘I’m going to give as cause of death the fractured pelvis with
haemorrhages and fat emboli. For part two – that’s the associated findings
of course – I’m going to add the cirrhosis, diabetes, etc. as underlying
conditions.’
He stared at me.
‘So! It was the fractures!’
‘What I give is my opinion about the cause of death. Others may disagree
and in the end it’ll be up to the CPS to decide if they want to prosecute. I
think they should. But, knowing the CPS nowadays …’ I rolled my eyes.
‘Of course, finally it’s up to a jury to decide if that’s beyond reasonable
doubt or not.’
‘They can’t decide if he’s not been prosecuted. Thanks, Doc. I tell you,
I’ll be arresting that son-in-law for manslaughter.’
‘The CPS will only let you do that if they’re sure they can win the case,
and right now they’re not sure.’
‘What’s stopping them?’
‘They want me to give more weight to the pelvic fractures.’
He looked at me narrowly.
‘Well, can you, Doc?’
I stared back at him over the drowned body.
‘I’ve gone as far as my conscience allows.’
‘But –’
‘My cause of death says it all. She died from complications of her pelvic
fractures but she was already an ill lady with several chronic diseases. You
take your victims as you find them, right? If some minion at the CPS can’t
understand what I’ve written – and I don’t think they can – and they’ve
point-blank declined my request for a meeting so I can explain my findings
and reasons, what more can I do?’
‘Doc –’
‘I’ve been fair. That’s my job, to be fair.’
At this point detectives can get very annoyed with pathologists, so I
concentrated on the body in front of me. I had a suspicion that this was
going to be one of those cases of death by urination. We know that drunks
can be unstable and wobble. Not normally too much of an issue, even when
urinating, although it does make for messy bathrooms. However, wobbling
can become an issue if drunks stop on the way home to relieve themselves
in a river or a lake. Then, if they wobble a bit too far, a treacherous
combination suddenly occurs: they are both staggering drunk and immersed
in cold water.
I examined the man’s body carefully for marks of the punch-up his
family were convinced had killed him. A few minor bruises … a very few
lacerations, which looked as if they had happened in the river. And the
crucial findings – flies undone and penis exposed. I was just sure I’d find a
full bladder when I examined his pelvis. And there was a lot of froth
exuding from his mouth and nose, a classic sign of drowning. So, the man
was alive when he entered the water, and then … I was concentrating so
hard that I had almost forgotten the angry detective.
‘Doc …?’
I looked up and blinked at him.
‘I really admire you.’
I blinked harder. No police officer had said such a thing to me before.
Ever.
‘You’ve done a job all these years that most people don’t even want to
think about. And you’re still fascinated – I can tell by watching you. Here’s
some idiot who pegged it, probably because he fell over peeing while
pissed. That woman was a hopeless alcoholic who was at death’s door
anyway. And you still care about them. No matter what, you care enough to
be fair.’
Behind us the mortuary clanged as wagons moved the dead around.
Nearby, in the softly lit, pastel-painted bereavement room, a relative sobbed
loudly. Around us the group of police officers waited, watching the knife in
my hand. I looked at the body before me. Overweight, balding, fingers
puckered and whitened, some skin slippage, a bit of decomposition, a lot of
bad luck. My fellow man.
I tried to respond to the detective’s words with a light-hearted,
throwaway line. Something about how I still loved solving puzzles after
forty years. But I couldn’t. Because I knew he was right. I did care. And I
still do.
Author’s Note
It was difficult for me to take the decision to change names and identifying
details in this book because I’ve spent a working life striving for accuracy.
However, I’ve also spent a working life trying to alleviate the suffering of
the bereaved and it would help no one to recognize a relative in these pages
and revisit their darkest days here. So only the names of those who are so
famous they are impossible to disguise are given. In all other cases I have
changed details to preserve confidentiality while maintaining relevant facts.
Acknowledgements
I have been very fortunate to spend my career working in a profession
which has fascinated me from the first moment I knew it existed. But it is
only when I look back over forty fleeting years that I realize what a crucial
part family, friends and colleagues have played. I remember them all but
they are, of course, far too numerous to list, so here I thank just a few of
them. Dr Rufus Crompton and Professor Bill Robertson – they created a job
especially for me to study forensic pathology at St George’s Hospital and
showed me the path ahead.
The many coroners I have worked for and with, including Paul Knapman,
John Burton, David Paul, Alison Thompson, Michael Burgess – they have
helped me to give understanding and closure to so many devastated
families.
My colleagues at Guy’s Hospital, Dr Iain West, Dr Vesna Djurovic and
Dr Ian Hill. And, of course, The Forensic Medicine Unit at St George’s: Dr
Robert Chapman, Dr Margaret Stark and Dr Debbi Rogers, as well as the
indefatigable Rhiannon Layne and the ever-cheerful Kathy Paylor.
Not forgetting the staff in mortuaries all over the country for their
immense skills so seldom recognized or praised and for their friendship,
support and, of course, cups of tea! I have worked in courts of all sorts in
the UK and abroad and the court staff have always been polite and helpful. I
must mention in particular the staff at the Old Bailey, some of whom I’ve
got to know well during the many hours I have spent waiting to give
evidence. And I’ve always been grateful for their cheery smiles and
encouraging words after the occasional mauling by a truculent barrister. The
many police officers I have worked with, but particularly Steve Gwilliam:
he was a wonderful colleague and we rather grew up together professionally
in the early years. And it was he who taught me to fly and opened up a
whole new world. The many solicitors, barristers and judges with whom it
has been a pleasure to work. And then, of course, my family. First Jen, who
was such a support to me as my career developed and whose determination
in the years we spent together took her own medical career into areas she
had never previously contemplated. I am inordinately proud of our children,
Chris and Anna, and of my grandchildren, Austin and Iona. And Linda, my
wonderful wife and the constant point in my life, who keeps my feet on the
ground and who has taught me to love our garden. Without her love and
support it would not have been possible at times to carry on. Plus of course
the three ‘additions’ I am very pleased to say she brought with her –
Rachael, Sarah and Lydia. Thank you, to all of my family, for your
strenuous efforts to prevent me growing old and even the slightest bit
pompous.
It was the patience and support of Mark Lucas and Rowland White and
all of his fine team, but especially Ariel Pakier, at Michael Joseph who
steered the craft you now hold in your hands to a safe landing and I thank
them wholeheartedly for this.
Finally, my current Jack Russells, Archie and Bertie, and their
predecessors who have been my ever-present companions, personal trainers
and totally tolerant confidants.
THE BEGINNING
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MICHAEL JOSEPH
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First published 2018
Copyright © Richard Shepherd, 2018
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ISBN: 978-1-405-92355-2